Provider Demographics
NPI:1851672190
Name:HEARNS, MANDEL JERMAINE (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:MANDEL
Middle Name:JERMAINE
Last Name:HEARNS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9455 WOODLEIGH MILL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-7918
Mailing Address - Country:US
Mailing Address - Phone:904-778-1750
Mailing Address - Fax:
Practice Address - Street 1:9700 ARGYLE FOREST BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-2809
Practice Address - Country:US
Practice Address - Phone:904-778-0871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist