Healthcare Provider Details

I. General information

NPI: 1659619146
Provider Name (Legal Business Name): JENNIFER VAJANYI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 SR 524
COCOA FL
32926
US

IV. Provider business mailing address

1945 EVA LN
MALABAR FL
32950-3220
US

V. Phone/Fax

Practice location:
  • Phone: 321-636-6784
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS49488
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: