Provider Demographics
NPI:1437188810
Name:DESRUISSEAU, JENNIFER ELLEN (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELLEN
Last Name:DESRUISSEAU
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 1:200 2ND AVE S # 489
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4313
Mailing Address - Country:US
Mailing Address - Phone:907-360-1566
Mailing Address - Fax:
Practice Address - Street 1:326 LING A MOR TER S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-3655
Practice Address - Country:US
Practice Address - Phone:907-360-1566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS342701835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy