Healthcare Provider Details

I. General information

NPI: 1932705548
Provider Name (Legal Business Name): MYLE DAO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5634 MERRILL RD
JACKSONVILLE FL
32277-3306
US

IV. Provider business mailing address

5634 MERRILL RD
JACKSONVILLE FL
32277-3306
US

V. Phone/Fax

Practice location:
  • Phone: 904-743-0109
  • Fax: 904-743-0192
Mailing address:
  • Phone: 904-743-0109
  • Fax: 904-743-0192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS52190
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: