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NPI Code Detail

MEDICARE: LUKESON GIDEON VERSULIEN

MEDICARE: LUKESON GIDEON VERSULIEN
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
1183500000XPharmacistPS60853FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11497760680OTHERFLNPI

General Provider Information

NPI Number : 1932718715
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUKESON GIDEON VERSULIEN
Provider Business Mailing Address
First Line : 9700 ARGYLE FOREST BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32222-2809
Country : US
Telephone Number : 904-778-0871
Fax Number : 904-778-9493
Provider Business Practice Location Address
First Line : 9700 ARGYLE FOREST BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32222-2809
Country : US
Telephone Number : 904-778-0871
Fax Number : 904-778-9493
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2020
Last Update Date : 07/28/2020

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Directions to “ LUKESON GIDEON VERSULIEN ” Practice Location

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