Provider Demographics
NPI:1023800364
Name:INTEREST, JESSICA L (SCPHT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:INTEREST
Suffix:
Gender:F
Credentials:SCPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-3205
Mailing Address - Country:US
Mailing Address - Phone:561-540-4423
Mailing Address - Fax:
Practice Address - Street 1:105 E OCEAN AVE
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-3205
Practice Address - Country:US
Practice Address - Phone:561-540-4423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT93690183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician