MEDICARE: JERRY VOLTAIRE

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	333600000X	Pharmacy	PSI39991	FL
2	3336C0003X	Community/Retail Pharmacy	PS64261	FL

General Provider Information

NPI Number	:	1447877287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY VOLTAIRE

Provider Business Mailing Address
First Line	:	3915 W COMMERCIAL BLVD
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33309-3317
Country	:	US
Telephone Number	:	954-733-2552
Fax Number	:

Provider Business Practice Location Address
First Line	:	3915 W COMMERCIAL BLVD
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33309-3317
Country	:	US
Telephone Number	:	954-733-2552
Fax Number	:

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

Provider Enumeration Date	:	06/27/2020
Last Update Date	:	07/25/2022

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Directions to “ JERRY VOLTAIRE ” Practice Location

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