Provider Demographics
NPI:1538451158
Name:CONERLY-SYLVAS, JAIME (PHARM D)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:CONERLY-SYLVAS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-5544
Mailing Address - Country:US
Mailing Address - Phone:601-798-0330
Mailing Address - Fax:601-798-8507
Practice Address - Street 1:416 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-5544
Practice Address - Country:US
Practice Address - Phone:601-798-0330
Practice Address - Fax:601-798-8507
Is Sole Proprietor?:No
Enumeration Date:2011-05-15
Last Update Date:2011-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE9977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist