MEDICARE: HOPE RISING ENTERPRISE LLC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PH26757	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2139683	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346683216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE RISING ENTERPRISE LLC

Provider Business Mailing Address
First Line	:	936 ARLINGTON RD N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5956
Country	:	US
Telephone Number	:	904-724-4337
Fax Number	:	904-724-4329

Provider Business Practice Location Address
First Line	:	936 ARLINGTON RD N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5956
Country	:	US
Telephone Number	:	904-724-4337
Fax Number	:	904-724-4329

Authorized Official
Title or Position	:	OWNER, PIC, AO
Name	:	ALAN ABIDOGUN
Credential	:	RPH
Telephone Number	:	904-724-4337

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	04/12/2017

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Directions to “HOPE RISING ENTERPRISE LLC ” Practice Location

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