Provider Demographics
NPI:1144456252
Name:JEBROCK, JENNIFER L (PHARMD, BCPS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:JEBROCK
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 SW 4TH CT
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-7521
Mailing Address - Country:US
Mailing Address - Phone:305-585-7350
Mailing Address - Fax:305-585-7412
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:PHARMACY SERVICES, B069
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-7350
Practice Address - Fax:305-585-7412
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS427941835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy