Healthcare Provider Details

I. General information

NPI: 1295814820
Provider Name (Legal Business Name): KRISTI RENEE BLEDSOE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W 8TH ST
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

3507 COMPASS ROSE DR E
JACKSONVILLE FL
32216-6341
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-5774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS35350
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: