[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-388382-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-388382-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","license-verification-practitioner-print-friendly-ps61701","License Verification Practitioner Print Friendly - PS61701","","Practitioner license verification record from the Florida Department of Health, Division of Medical Quality Assurance. It lists a pharmacist license number PS61701 with license status “Clear/Active,” shows the license original issue date and expiration date (including collaborative practice certification to administer immunizations through 9/30/2027), and provides the practitioner’s recorded address and listed discipline information. The document also states whether emergency actions, discipline cases, and public complaints exist, and provides instructions to request public records for final orders if case-number links are 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9/24/2026 Profession License  \nLicense Status Qualifications  \nLicense Expiration Date License Original Issue Date  \nAddress of Record  \nDiscipline on File Public Complaint  \nPharmacist PS61701 Clear/Active  \nCollaborative Practice Certification Certified To Administer Immunizations 9/30/2027  \n09/30/2020  \n580 8th St W  \nTower II JACKSONVILLE, FL 32209 No  \nNo  \nSecondary Locations  \nNo secondary locations found.  \nDiscipline/Admin Action  \nEmergency Actions  \nNo Emergency Actions Found  \nDiscipline Cases  \nNo Discipline Found  \nPublic Complaints  \nNo Public Complaint Found  \nIfa link does not appear for the case number, we do not have a scanned copyof the final order available in our database. To obtain a paper copy, please contact Public Records by clicking the link below:  \nDiscipline Public Records Request  \nYou mayalso contact Public Records by telephone at (850) 245-4252, option 4 or bywritten correspondence at: Division of Medical QualityAssurance  \nPublic Records  \n4052 Bald Cypress Way, Bin C01 Tallahassee, FL 32399-3251  \nPlease include the following:  \n1. Full name and license number of the practitioner;  \n2. Name and address where documents are to be sent; and  \n3. If you require certification of the documents , a $25 fee will be charged, in addition to the duplicating charges . Certification of the requested records will not be done unless specifically requested. An invoice will be sent to you and payment will be expected within thirty days . Upon receipt of payment, material will be sent to you.  \nSupervising Practitioners  \nName Relationship Profession License Effective Date  \n\n| BRIMER, THOMAS CAMERON | CPC SUPERVISING PHYSICIAN | MEDICAL DOCTOR | 170741 | 06/12/2025 |\n| --- | --- | --- | --- | --- |\n| JAMALABADI GREY, SHAHRZAD | CPC SUPERVISING PHYSICIAN | MEDICAL DOCTOR | 94626 | 06/12/2025 |\n\nPATEL , BHAVESH SOMABHAI  \nCPC SUPERVISING PHYSICIAN  \nMEDICAL DOCTOR  \n84047  \n06/12/2025  \nClick on the License Number to view License Details for that Practitioner  \nThe information on this page is a secure, primary source for license verification provided by the Florida Department of Health, Division of Medical Quality Assurance. This website is maintained by Division sta f and is updated immediately upon a change to our licensing and enforcement database.  \nSecondary Locations  \nNo secondary locations found.  \nDiscipline/Admin Action  \nEmergency Actions  \nNo Emergency Actions Found  \nDiscipline Cases  \nNo Discipline Found  \nPublic Complaints  \nNo Public Complaint Found  \nIfa link does not appear for the case number, we do not have a scanned copyof the final order available in our database. To obtain a paper copy, please contact Public Records by clicking the link below:  \nDiscipline Public Records Request  \nYou mayalso contact Public Records by telephone at (850) 245-4252, option 4 or bywritten correspondence at: Division of Medical QualityAssurance  \nPublic Records  \n4052 Bald Cypress Way, Bin C01 Tallahassee, FL 32399-3251  \nPlease include the following:  \n1. Full name and license number of the practitioner;  \n2. Name and address where documents are to be sent; and  \n3. If you require certification of the documents , a $25 fee will be charged, in addition to the duplicating charges . Certification of the requested records will not be done unless specifically requested. An invoice will be sent to you and payment will be expected within thirty days . Upon receipt of payment, material will be sent to you.  \nSupervising Practitioners  \nName Relationship Profession License Effective Date  \n\n| BRIMER, THOMAS CAMERON | CPC SUPERVISING PHYSICIAN | MEDICAL DOCTOR | 170741 | 06/12/2025 |\n| --- | --- | --- | --- | --- |\n| JAMALABADI GREY, SHAHRZAD | CPC SUPERVISING PHYSICIAN | MEDICAL DOCTOR | 94626 | 06/12/2025 |\n\nPATEL , BHAVESH SOMABHAI CPC SUPERVISING PHYSICIAN MEDICAL DOCTOR 84047 06/12/2025  \nClick on the License Number to vi","cbCaiikuPGtUMEQ1","https://ap.wps.com/l/cbCaiikuPGtUMEQ1","pdf",77624,"English","# License Status and Dates\n## License Details\n## Discipline and Complaints\n## Public Records Request Instructions\n## Supervising Practitioners","[{\"question\":\"What is the practitioner’s license number and status?\",\"answer\":\"The practitioner’s license number is PS61701 and the license status is Clear/Active.\"},{\"question\":\"When does the collaborative practice certification to administer immunizations expire?\",\"answer\":\"The collaborative practice certification is certified to administer immunizations until 9/30/2027.\"},{\"question\":\"What should a requester include when requesting certified public records?\",\"answer\":\"Include the practitioner’s full name and license number, the name and address where documents should be sent, and note that certification requires a $25 fee in addition to duplicating charges.\"}]","License Verification Practitioner Print Friendly - PS61701 | PDF",1790302483]