Provider Demographics
NPI:1235671975
Name:MONTEJO, JADE DIANA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JADE
Middle Name:DIANA
Last Name:MONTEJO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 FLAMANGO LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-4308
Mailing Address - Country:US
Mailing Address - Phone:561-312-9806
Mailing Address - Fax:
Practice Address - Street 1:2820 FLAMANGO LAKE DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-4308
Practice Address - Country:US
Practice Address - Phone:561-312-9806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53760183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist