Healthcare Provider Details

I. General information

NPI: 1992391205
Provider Name (Legal Business Name): KATELYN-ROSE HURLEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 BEACH BLVD
JACKSONVILLE FL
32216-2702
US

IV. Provider business mailing address

6006 BEACH BLVD
JACKSONVILLE FL
32216-2702
US

V. Phone/Fax

Practice location:
  • Phone: 508-505-7717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS61583
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: