Healthcare Provider Details

I. General information

NPI: 1245358423
Provider Name (Legal Business Name): GLORIA AMARACHUKWU EZE DR.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST
JACKSONVILLE FL
32214-1219
US

IV. Provider business mailing address

1406 CLEMENTSON DR
SAN ANTONIO TX
78260-6279
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-9412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number48482
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number48482
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17731
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: