Healthcare Provider Details

I. General information

NPI: 1457958589
Provider Name (Legal Business Name): DR. CHARDAE WHITNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7307 N MAIN ST
JACKSONVILLE FL
32208-4123
US

IV. Provider business mailing address

7307 N MAIN ST
JACKSONVILLE FL
32208-4123
US

V. Phone/Fax

Practice location:
  • Phone: 904-765-3531
  • Fax:
Mailing address:
  • Phone: 904-765-3531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS61701
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: