Provider Demographics
NPI:1518567163
Name:MCLEOD, JENNEFER B (RPH)
Entity Type:Individual
Prefix:
First Name:JENNEFER
Middle Name:B
Last Name:MCLEOD
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 1:10534 S SALT RD
Mailing Address - Street 2:
Mailing Address - City:LAMONT
Mailing Address - State:FL
Mailing Address - Zip Code:32336-7510
Mailing Address - Country:US
Mailing Address - Phone:850-509-5546
Mailing Address - Fax:
Practice Address - Street 1:5500 THOMASVILLE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-3814
Practice Address - Country:US
Practice Address - Phone:850-668-0054
Practice Address - Fax:850-668-0683
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist