MEDICARE: MRS. JADE DIANA MONTEJO PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS53760	FL

General Provider Information

NPI Number	:	1235671975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JADE DIANA MONTEJO PHARM.D.

Provider Business Mailing Address
First Line	:	2820 FLAMANGO LAKE DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-4308
Country	:	US
Telephone Number	:	561-312-9806
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 FLAMANGO LAKE DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-4308
Country	:	US
Telephone Number	:	561-312-9806
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2016
Last Update Date	:	11/11/2016

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