Provider Demographics
NPI:1689279572
Name:JARAMILLO, SHIELA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHIELA
Middle Name:
Last Name:JARAMILLO
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 1:900 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE BUTLER
Mailing Address - State:FL
Mailing Address - Zip Code:32054-1360
Mailing Address - Country:US
Mailing Address - Phone:386-496-1685
Mailing Address - Fax:386-496-0753
Practice Address - Street 1:900 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE BUTLER
Practice Address - State:FL
Practice Address - Zip Code:32054-1360
Practice Address - Country:US
Practice Address - Phone:386-496-1685
Practice Address - Fax:386-496-0753
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist