Healthcare Provider Details

I. General information

NPI: 1821746090
Provider Name (Legal Business Name): HARDEN-GIVENS ENTERPRISE , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 MONCRIEF RD # SET101
JACKSONVILLE FL
32209-4340
US

IV. Provider business mailing address

4220 MONCRIEF RD
JACKSONVILLE FL
32209-3976
US

V. Phone/Fax

Practice location:
  • Phone: 904-900-1491
  • Fax: 904-423-0426
Mailing address:
  • Phone: 904-603-1654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SYLVESTER JOSHUA HARDEN-GIVENS
Title or Position: OWNER
Credential:
Phone: 904-603-1654