MEDICARE: DR. JACQUELINE SAMANTHA DEMARCO 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	1835N1003X	Nutrition Support Pharmacist	PS57580	FL
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	054059	NY
3	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PS57580	FL
4	183500000X	Pharmacist	054059	NY
5	183500000X	Pharmacist	PS57580	FL
6	1835N1003X	Nutrition Support Pharmacist	054059	NY

General Provider Information

NPI Number	:	1609190305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE SAMANTHA DEMARCO PHARM.D.

Provider Business Mailing Address
First Line	:	6 MONTROSE DR
Second Line	:
City	:	COMMACK
State	:	NY
Zip	:	11725-1313
Country	:	US
Telephone Number	:	631-300-6320
Fax Number	:

Provider Business Practice Location Address
First Line	:	11140 LYNWOOD PALM WAY
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33412-2470
Country	:	US
Telephone Number	:	631-300-6320
Fax Number	:	954-208-0066

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

Provider Enumeration Date	:	03/24/2010
Last Update Date	:	11/30/2021

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