Healthcare Provider Details

I. General information

NPI: 1831102763
Provider Name (Legal Business Name): AGAPE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 KING ST
JACKSONVILLE FL
32204-2410
US

IV. Provider business mailing address

900 UNIVERSITY BLVD N MC-96
JACKSONVILLE FL
32211-9230
US

V. Phone/Fax

Practice location:
  • Phone: 904-253-1540
  • Fax: 904-253-1890
Mailing address:
  • Phone: 904-253-1540
  • Fax: 904-924-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPH19420
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LEMORRIS PRIER
Title or Position: DIRTR OF PHCY
Credential: PHARM.D
Phone: 904-253-2461