Provider Demographics
NPI:1730347568
Name:OLIVE, JEMILLE R (PHARMD)
Entity type:Individual
Prefix:
First Name:JEMILLE
Middle Name:R
Last Name:OLIVE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32341-5008
Mailing Address - Country:US
Mailing Address - Phone:850-973-1317
Mailing Address - Fax:850-973-3748
Practice Address - Street 1:139 SW MACON STREET
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-2319
Practice Address - Country:US
Practice Address - Phone:850-973-8120
Practice Address - Fax:850-973-8122
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist