MEDICARE: MR. JEREMY ZELLERS RPH

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	PH3314	DC
2	183500000X	Pharmacist	PS47646	FL
3	183500000X	Pharmacist	RP044100L	PA
4	183500000X	Pharmacist	0202208360	VA

General Provider Information

NPI Number	:	1366818080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEREMY ZELLERS RPH

Provider Business Mailing Address
First Line	:	2307 NE 16TH AVE
Second Line	:
City	:	WILTON MANORS
State	:	FL
Zip	:	33305-2405
Country	:	US
Telephone Number	:	202-321-7290
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 SE 3RD AVE FL 4
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1139
Country	:	US
Telephone Number	:	954-522-3132
Fax Number	:

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

Provider Enumeration Date	:	08/17/2015
Last Update Date	:	08/17/2015

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