Provider Demographics
NPI:1366818080
Name:ZELLERS, JEREMY (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:ZELLERS
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 1:2307 NE 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2405
Mailing Address - Country:US
Mailing Address - Phone:202-321-7290
Mailing Address - Fax:
Practice Address - Street 1:700 SE 3RD AVE FL 4
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1139
Practice Address - Country:US
Practice Address - Phone:954-522-3132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH3314183500000X
FLPS47646183500000X
PARP044100L183500000X
VA0202208360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist