Provider Demographics
NPI:1437759743
Name:WIENS, JAIME (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
Last Name:WIENS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N MIRAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3002
Mailing Address - Country:US
Mailing Address - Phone:321-339-5012
Mailing Address - Fax:
Practice Address - Street 1:700 N MIRAMAR AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3002
Practice Address - Country:US
Practice Address - Phone:321-339-5012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist