Healthcare Provider Details

I. General information

NPI: 1104813757
Provider Name (Legal Business Name): JENNIFER DEVANE KHOURY PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD PHARMACY (119)
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

11511 NW 13TH LN
GAINESVILLE FL
32606-0426
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax:
Mailing address:
  • Phone: 352-333-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS38781
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: