Healthcare Provider Details

I. General information

NPI: 1831026392
Provider Name (Legal Business Name): JERONIMO QUINTERO MEJIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 BAYARD AVE NE
PALM BAY FL
32907-1912
US

IV. Provider business mailing address

499 BAYARD AVE NE
PALM BAY FL
32907-1912
US

V. Phone/Fax

Practice location:
  • Phone: 561-291-3679
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number363063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: