Provider Demographics
NPI:1417130469
Name:PINTA, JADE A (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JADE
Middle Name:A
Last Name:PINTA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 INVERNESS CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-5811
Mailing Address - Country:US
Mailing Address - Phone:239-995-5007
Mailing Address - Fax:
Practice Address - Street 1:5703 INVERNESS CIR
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-5811
Practice Address - Country:US
Practice Address - Phone:239-995-5007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 15498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPU 3259OtherCONSULTANT PHARMACIST