Healthcare Provider Details

I. General information

NPI: 1235237132
Provider Name (Legal Business Name): PARK & KING PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4163 OXFORD AVE
JACKSONVILLE FL
32210-4425
US

IV. Provider business mailing address

4163 OXFORD AVE
JACKSONVILLE FL
32210-4425
US

V. Phone/Fax

Practice location:
  • Phone: 904-389-6602
  • Fax: 904-389-7062
Mailing address:
  • Phone: 904-389-6602
  • Fax: 904-389-7062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH9341
License Number StateFL

VIII. Authorized Official

Name: GREG CARTER
Title or Position: OWNER
Credential: BSRRT
Phone: 904-389-6602