Healthcare Provider Details

I. General information

NPI: 1326680455
Provider Name (Legal Business Name): JACQUELINE EVE PLOURDE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 LAKELAND HILLS BLVD
LAKELAND FL
33805-4543
US

IV. Provider business mailing address

416 DOWN PINE DR
SEFFNER FL
33584-3719
US

V. Phone/Fax

Practice location:
  • Phone: 863-284-1834
  • Fax:
Mailing address:
  • Phone: 954-829-4895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS60127
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: