MEDICARE: JESSICA ROLLER PHARMD

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	46801	FL

General Provider Information

NPI Number	:	1417304130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ROLLER PHARMD

Provider Business Mailing Address
First Line	:	220 FRONT ST
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-5022
Country	:	US
Telephone Number	:	904-280-5441
Fax Number	:	904-567-8596

Provider Business Practice Location Address
First Line	:	220 FRONT ST
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-5022
Country	:	US
Telephone Number	:	904-280-5441
Fax Number	:	904-567-8596

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

Provider Enumeration Date	:	05/23/2016
Last Update Date	:	08/19/2020

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Directions to “ JESSICA ROLLER PHARMD” Practice Location

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