Provider Demographics
NPI:1770261083
Name:JAIMAN, ALYSSA CLAIRE
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:CLAIRE
Last Name:JAIMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 BARON RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-5469
Mailing Address - Country:US
Mailing Address - Phone:407-409-0434
Mailing Address - Fax:
Practice Address - Street 1:16900 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32820-1911
Practice Address - Country:US
Practice Address - Phone:407-568-4199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist