Provider Demographics
NPI:1811498009
Name:DOHERTY, JENNIFER CAROLYN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CAROLYN
Last Name:DOHERTY
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 1:4157A OLD JENNINGS RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-3742
Mailing Address - Country:US
Mailing Address - Phone:904-589-4159
Mailing Address - Fax:
Practice Address - Street 1:410 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5051
Practice Address - Country:US
Practice Address - Phone:904-276-6035
Practice Address - Fax:904-276-6095
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist