Healthcare Provider Details

I. General information

NPI: 1518930536
Provider Name (Legal Business Name): NAVAL HOSPITAL NAS JACKSONVILLE PHARMACY DEPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST
JACKSONVILLE FL
32214-5005
US

IV. Provider business mailing address

8195 CONCORD BLVD E
JACKSONVILLE FL
32208-2831
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7406
  • Fax:
Mailing address:
  • Phone: 904-765-2812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number19012
License Number StateFL

VIII. Authorized Official

Name: MRS. ANWULI AYO MADUAKA-CAIN
Title or Position: PHARMACIST
Credential:
Phone: 904-542-7406