Provider Demographics
NPI:1851801591
Name:MYERS, JAIMIE NICOLE (PHARMD CANDIDATE)
Entity Type:Individual
Prefix:
First Name:JAIMIE
Middle Name:NICOLE
Last Name:MYERS
Suffix:
Gender:F
Credentials:PHARMD CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 W ESTRELLA ST APT 3
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6175
Mailing Address - Country:US
Mailing Address - Phone:727-480-8874
Mailing Address - Fax:
Practice Address - Street 1:1899 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-2156
Practice Address - Country:US
Practice Address - Phone:727-441-4585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI35965390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program