Provider Demographics
NPI:1609190305
Name:DEMARCO, JACQUELINE SAMANTHA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:SAMANTHA
Last Name:DEMARCO
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 1:6 MONTROSE DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1313
Mailing Address - Country:US
Mailing Address - Phone:631-300-6320
Mailing Address - Fax:
Practice Address - Street 1:11140 LYNWOOD PALM WAY
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33412-2470
Practice Address - Country:US
Practice Address - Phone:631-300-6320
Practice Address - Fax:954-208-0066
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS575801835N1003X, 1835P0018X, 183500000X
NY0540591835P0018X, 183500000X, 1835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No183500000XPharmacy Service ProvidersPharmacist