Healthcare Provider Details

I. General information

NPI: 1013294180
Provider Name (Legal Business Name): JENNIFER HERWIG R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6275 NAPLES BLVD
NAPLES FL
34109-2030
US

IV. Provider business mailing address

6275 NAPLES BLVD
NAPLES FL
34109-2030
US

V. Phone/Fax

Practice location:
  • Phone: 239-596-6410
  • Fax: 239-596-6427
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS33403
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: