Healthcare Provider Details

I. General information

NPI: 1700166311
Provider Name (Legal Business Name): ASA CLARK HINKLEY PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2839 COUNTY ROAD 210 W
JACKSONVILLE FL
32259-2016
US

IV. Provider business mailing address

5988 SHADEHILL RD
JACKSONVILLE FL
32258-5192
US

V. Phone/Fax

Practice location:
  • Phone: 904-287-5476
  • Fax: 904-287-8442
Mailing address:
  • Phone: 904-262-3302
  • Fax: 904-287-8442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS37139
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: