Healthcare Provider Details

I. General information

NPI: 1689274268
Provider Name (Legal Business Name): EBONY ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2020
Last Update Date: 10/31/2020
Certification Date: 10/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9890 HUTCHINSON PARK DR
JACKSONVILLE FL
32225-7205
US

IV. Provider business mailing address

9890 HUTCHINSON PARK DR
JACKSONVILLE FL
32225-7205
US

V. Phone/Fax

Practice location:
  • Phone: 904-721-4699
  • Fax:
Mailing address:
  • Phone: 904-721-4699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS46864
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: