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NPI Code Detail

MEDICARE: AUQUILA DATAVERIA LOCKE RPH

MEDICARE:   AUQUILA DATAVERIA LOCKE  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
1183500000XPharmacistPS34009FL

General Provider Information

NPI Number : 1568742195
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUQUILA DATAVERIA LOCKE RPH
Provider Business Mailing Address
First Line : 3044 POSTMILL DR
Second Line :
City : ORANGE PARK
State : FL
Zip : 32073-7688
Country : US
Telephone Number : 904-727-6626
Fax Number : 904-727-9890
Provider Business Practice Location Address
First Line : 6006 BEACH BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-2702
Country : US
Telephone Number : 904-727-6626
Fax Number : 904-727-9890
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2011
Last Update Date : 08/26/2011

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Directions to “ AUQUILA DATAVERIA LOCKE RPH” Practice Location

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