Healthcare Provider Details

I. General information

NPI: 1992490163
Provider Name (Legal Business Name): JESSICA EDGAR PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10075 S JOG RD STE 101
BOYNTON BEACH FL
33437-3532
US

IV. Provider business mailing address

10075 S JOG RD STE 101
BOYNTON BEACH FL
33437-3532
US

V. Phone/Fax

Practice location:
  • Phone: 561-408-0796
  • Fax: 561-652-8653
Mailing address:
  • Phone: 561-408-0796
  • Fax: 561-652-8653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS64386
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: