Healthcare Provider Details

I. General information

NPI: 1689279572
Provider Name (Legal Business Name): SHIELA JARAMILLO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MAIN ST
LAKE BUTLER FL
32054-1360
US

IV. Provider business mailing address

900 E MAIN ST
LAKE BUTLER FL
32054-1360
US

V. Phone/Fax

Practice location:
  • Phone: 386-496-1685
  • Fax: 386-496-0753
Mailing address:
  • Phone: 386-496-1685
  • Fax: 386-496-0753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS56542
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: