Provider Demographics
NPI:1518587401
Name:HERRERA, JESSY
Entity Type:Individual
Prefix:
First Name:JESSY
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 KEY PLZ
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4076
Mailing Address - Country:US
Mailing Address - Phone:305-295-8050
Mailing Address - Fax:305-742-0518
Practice Address - Street 1:1112 KEY PLZ
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4076
Practice Address - Country:US
Practice Address - Phone:305-295-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician