Provider Demographics
NPI:1891136529
Name:ADELSON, JACQUES H (PH)
Entity Type:Individual
Prefix:
First Name:JACQUES
Middle Name:H
Last Name:ADELSON
Suffix:
Gender:M
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7121 HIAWASSEE OAK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-8357
Mailing Address - Country:US
Mailing Address - Phone:407-485-0575
Mailing Address - Fax:
Practice Address - Street 1:5431 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-2921
Practice Address - Country:US
Practice Address - Phone:954-485-4949
Practice Address - Fax:954-485-4948
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist