Provider Demographics
NPI:1417404898
Name:JARVIS, CHAD
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:JARVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2241 SE HEATHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-6927
Mailing Address - Country:US
Mailing Address - Phone:772-486-4345
Mailing Address - Fax:
Practice Address - Street 1:2241 SE HEATHWOOD CIR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-6927
Practice Address - Country:US
Practice Address - Phone:772-486-4345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist