Provider Demographics
NPI:1508140161
Name:FLEETWOOD, JAMIE LARRIMORE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LARRIMORE
Last Name:FLEETWOOD
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 1:21400 ZEEMAN RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21661-1515
Mailing Address - Country:US
Mailing Address - Phone:410-639-9140
Mailing Address - Fax:
Practice Address - Street 1:21400 ZEEMAN RD
Practice Address - Street 2:
Practice Address - City:ROCK HALL
Practice Address - State:MD
Practice Address - Zip Code:21661-1515
Practice Address - Country:US
Practice Address - Phone:410-639-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist