Healthcare Provider Details

I. General information

NPI: 1528694072
Provider Name (Legal Business Name): ALYSSA NICOLE DUANE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7307 N MAIN ST
JACKSONVILLE FL
32208-4123
US

IV. Provider business mailing address

7707 MERRILL RD UNIT 8664
JACKSONVILLE FL
32239-7728
US

V. Phone/Fax

Practice location:
  • Phone: 904-765-3531
  • Fax: 904-765-3533
Mailing address:
  • Phone: 904-765-3531
  • Fax: 904-765-3533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS0050424
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: