Provider Demographics
NPI:1689603003
Name:SHERLINE, JAY A (RPH)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:A
Last Name:SHERLINE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3563 PHILLIPS HWY
Mailing Address - Street 2:BLD A, STE 106
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5663
Mailing Address - Country:US
Mailing Address - Phone:904-202-5261
Mailing Address - Fax:904-202-5273
Practice Address - Street 1:3583 PHILLIPS HWY
Practice Address - Street 2:BUILDING A, SUITE 106
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5611
Practice Address - Country:US
Practice Address - Phone:904-202-5261
Practice Address - Fax:904-202-5273
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS12936183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist