Healthcare Provider Details

I. General information

NPI: 1548175540
Provider Name (Legal Business Name): VANESSA JOSEPH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 NE JENSEN BEACH BLVD
JENSEN BEACH FL
34957-7221
US

IV. Provider business mailing address

1453 CAPTAINS WALK # 28B
FORT PIERCE FL
34950-6930
US

V. Phone/Fax

Practice location:
  • Phone: 772-334-4204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS70667
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: