Provider Demographics
NPI:1952695769
Name:PALENIK, JEREMY R (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:R
Last Name:PALENIK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6331 ROOSEVELT BLVD
Mailing Address - Street 2:T-1853
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-3303
Mailing Address - Country:US
Mailing Address - Phone:904-596-1066
Mailing Address - Fax:904-596-1066
Practice Address - Street 1:6331 ROOSEVELT BLVD
Practice Address - Street 2:T-1853
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-3303
Practice Address - Country:US
Practice Address - Phone:904-596-1066
Practice Address - Fax:904-596-1066
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist