Provider Demographics
NPI:1376813287
Name:JEAN, JOSEPH NEVELUS (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:NEVELUS
Last Name:JEAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 WADING BIRD CIR SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-6411
Mailing Address - Country:US
Mailing Address - Phone:321-608-8171
Mailing Address - Fax:
Practice Address - Street 1:999 SEBASTIAN BLVD
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-4861
Practice Address - Country:US
Practice Address - Phone:772-388-1096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist