Provider Demographics
NPI:1134748239
Name:CASWELL, JACKIE LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:LYNN
Last Name:CASWELL
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 1:3135 STATE ROAD 580 STE 1
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-4917
Mailing Address - Country:US
Mailing Address - Phone:727-259-2000
Mailing Address - Fax:727-259-2001
Practice Address - Street 1:3135 SR 580 SUITE 1
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695
Practice Address - Country:US
Practice Address - Phone:727-259-2000
Practice Address - Fax:727-259-2001
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist