Provider Demographics
NPI:1679333637
Name:DE VERA, JAMIE CARMELA RAYMUNDO (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAMIE CARMELA
Middle Name:RAYMUNDO
Last Name:DE VERA
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 1:17880 PASEO LUNADA
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1295
Mailing Address - Country:US
Mailing Address - Phone:626-710-6890
Mailing Address - Fax:
Practice Address - Street 1:16975 BEAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1809
Practice Address - Country:US
Practice Address - Phone:760-947-7043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist