Healthcare Provider Details

I. General information

NPI: 1396520789
Provider Name (Legal Business Name): ANGELA ZWARYCZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13125 N MAIN ST
JACKSONVILLE FL
32218-2759
US

IV. Provider business mailing address

13125 N MAIN ST
JACKSONVILLE FL
32218-2759
US

V. Phone/Fax

Practice location:
  • Phone: 904-596-1653
  • Fax:
Mailing address:
  • Phone: 904-596-1653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS66191
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: