Provider Demographics
NPI:1730792474
Name:CHAVES, JONATAS SILVA
Entity type:Individual
Prefix:
First Name:JONATAS
Middle Name:SILVA
Last Name:CHAVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4096 MARINER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-2465
Mailing Address - Country:US
Mailing Address - Phone:352-200-5031
Mailing Address - Fax:
Practice Address - Street 1:4096 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-2465
Practice Address - Country:US
Practice Address - Phone:352-200-5031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2022-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60456183500000X
NJ28RI03827700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist