Healthcare Provider Details

I. General information

NPI: 1114967304
Provider Name (Legal Business Name): TRACEY D. ROBINSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST
JACKSONVILLE FL
32214-5005
US

IV. Provider business mailing address

2080 CHILD ST
JACKSONVILLE FL
32214-8204
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7406
  • Fax:
Mailing address:
  • Phone: 904-542-7948
  • Fax: 904-542-7394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS33067
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS33067
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: