Provider Demographics
NPI:1013290246
Name:GRODITSKI, JENNIFER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:GRODITSKI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10320 SW STEPHANIE WAY APT 101
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-1966
Mailing Address - Country:US
Mailing Address - Phone:772-341-4600
Mailing Address - Fax:
Practice Address - Street 1:2592 S JENKINS RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-5310
Practice Address - Country:US
Practice Address - Phone:772-429-3174
Practice Address - Fax:772-429-3180
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist