MEDICARE: CHARLES JORDAN GUESS PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS51547	FL

General Provider Information

NPI Number	:	1053725721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES JORDAN GUESS PHARM.D.

Provider Business Mailing Address
First Line	:	2448 CAMPHORWOOD CT
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-6291
Country	:	US
Telephone Number	:	904-868-9408
Fax Number	:

Provider Business Practice Location Address
First Line	:	6331 ROOSEVELT BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-3303
Country	:	US
Telephone Number	:	904-596-1066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2014
Last Update Date	:	06/20/2014

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