MEDICARE: JERONIMO QUINTERO MEJIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	363063	FL

General Provider Information

NPI Number	:	1831026392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERONIMO QUINTERO MEJIA

Provider Business Mailing Address
First Line	:	499 BAYARD AVE NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-1912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	499 BAYARD AVE NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-1912
Country	:	US
Telephone Number	:	561-291-3679
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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