MEDICARE: MS. LATANYA RENE SIMON-CHAPPELL RPH

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	PH0023313	FL

General Provider Information

NPI Number	:	1447235700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LATANYA RENE SIMON-CHAPPELL RPH

Provider Business Mailing Address
First Line	:	4090 HODGES BLVD
Second Line	:	#4205
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-4204
Country	:	US
Telephone Number	:	904-821-8932
Fax Number	:

Provider Business Practice Location Address
First Line	:	4205 BELFORT RD
Second Line	:	#1003
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1471
Country	:	US
Telephone Number	:	904-296-4299
Fax Number	:

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	07/08/2007

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