Healthcare Provider Details

I. General information

NPI: 1891413803
Provider Name (Legal Business Name): ILVA XHEMALI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11250 OLD SAINT AUGUSTINE RD STE 4
JACKSONVILLE FL
32257-1147
US

IV. Provider business mailing address

9440 GENNA TRACE TRL
JACKSONVILLE FL
32257-8000
US

V. Phone/Fax

Practice location:
  • Phone: 904-262-4250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number64638
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: