Provider Demographics
NPI:1326207432
Name:MCSWEEN, JELLINO (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JELLINO
Middle Name:
Last Name:MCSWEEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 SW 151ST TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3620
Mailing Address - Country:US
Mailing Address - Phone:954-562-7849
Mailing Address - Fax:954-392-5022
Practice Address - Street 1:4950 SW 151ST TER
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3620
Practice Address - Country:US
Practice Address - Phone:954-350-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 34909183500000X
VA0202217069183500000X
KY019828183500000X
TX62247183500000X
ARPD14374183500000X
NC27644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist