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General NPI Number Information
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NPI Number | 1851672190
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Entity Type | Individual
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Provider Name | MANDEL JERMAINE HEARNS PHARM. D
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Gender | Male
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Dates
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Enumeration Date | 08/31/2011
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Last Update Date | 08/31/2011
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Provider Practice Location Address
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Address Line | 9700 ARGYLE FOREST BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32222-2809
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Country | US
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Telephone | 904-778-0871
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Fax |
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Provider Business Mailing Address
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Address Line | 9455 WOODLEIGH MILL DR
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City | JACKSONVILLE
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State | FL
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Zip | 32244-7918
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Country | US
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Telephone | 904-778-1750
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS33463
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License Number State | FL
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