Basic Information
| Provider Information | |||||||||
| NPI: | 1134748239 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASWELL | ||||||||
| FirstName: | JACKIE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3135 STATE ROAD 580 STE 1 | ||||||||
| Address2: | |||||||||
| City: | SAFETY HARBOR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346954917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272592000 | ||||||||
| FaxNumber: | 7272592001 | ||||||||
| Practice Location | |||||||||
| Address1: | 3135 SR 580 SUITE 1 | ||||||||
| Address2: | |||||||||
| City: | SAFETY HARBOR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272592000 | ||||||||
| FaxNumber: | 7272592001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2020 | ||||||||
| LastUpdateDate: | 04/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS28461 | FL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.