Healthcare Provider Details

I. General information

NPI: 1689669889
Provider Name (Legal Business Name): JERILYN B PETROPOULOS BS, PHARMD, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST (119)
MIAMI FL
33125-1624
US

IV. Provider business mailing address

200 SE 5TH AVE UNIT 508
DANIA BEACH FL
33004-4073
US

V. Phone/Fax

Practice location:
  • Phone: 888-276-1785
  • Fax:
Mailing address:
  • Phone: 954-927-4280
  • Fax: 305-575-3394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS32254
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS32254
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: