Healthcare Provider Details

I. General information

NPI: 1750206645
Provider Name (Legal Business Name): HUAN MAI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 HODGES BLVD FL 32224
JACKSONVILLE FL
32224-2216
US

IV. Provider business mailing address

4715 HODGES BLVD FL 32224
JACKSONVILLE FL
32224-2216
US

V. Phone/Fax

Practice location:
  • Phone: 904-992-4643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS71253
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: