Healthcare Provider Details

I. General information

NPI: 1417887696
Provider Name (Legal Business Name): PAMELA PESSEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 AVENTURINE AVE
SAINT AUGUSTINE FL
32086-0371
US

IV. Provider business mailing address

313 AVENTURINE AVE
ST AUGUSTINE FL
32086-0371
US

V. Phone/Fax

Practice location:
  • Phone: 904-742-0815
  • Fax:
Mailing address:
  • Phone: 904-742-0815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number37035
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: