Provider Demographics
NPI:1376888156
Name:HUMERICK, JEFFREY LYNN (RPH)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LYNN
Last Name:HUMERICK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 WOODBURY CT
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5088
Mailing Address - Country:US
Mailing Address - Phone:904-797-9474
Mailing Address - Fax:
Practice Address - Street 1:3305 WOODBURY CT
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5088
Practice Address - Country:US
Practice Address - Phone:904-797-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21349183500000X
FLPU6617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist