Provider Demographics
NPI:1366450470
Name:GUTTMAN, JEROME (RPH)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:GUTTMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 NW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7808
Mailing Address - Country:US
Mailing Address - Phone:954-474-3887
Mailing Address - Fax:954-474-3889
Practice Address - Street 1:201 NW 82ND AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7808
Practice Address - Country:US
Practice Address - Phone:954-474-3887
Practice Address - Fax:954-474-3889
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH11809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist