Provider Demographics
NPI:1710582663
Name:VERHOFF, JINCY LANDERS
Entity Type:Individual
Prefix:
First Name:JINCY
Middle Name:LANDERS
Last Name:VERHOFF
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 1:130 SCENIC GULF DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-4960
Mailing Address - Country:US
Mailing Address - Phone:850-837-3999
Mailing Address - Fax:850-837-3605
Practice Address - Street 1:130 SCENIC GULF DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-4960
Practice Address - Country:US
Practice Address - Phone:850-837-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL47346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47346OtherPHARMACIST