Healthcare Provider Details

I. General information

NPI: 1528487303
Provider Name (Legal Business Name): COMPLETE CARE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7254 GOLDEN WINGS RD UNIT 9
JACKSONVILLE FL
32244-3321
US

IV. Provider business mailing address

COMPLETE CARE PHARMACY 7254 GOLDEN WINGS RD SUITE 9
JACKSONVILLE FL
32244
US

V. Phone/Fax

Practice location:
  • Phone: 904-389-1104
  • Fax: 904-549-5631
Mailing address:
  • Phone: 904-389-1104
  • Fax: 904-549-5631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH28288
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KATIE PATEL
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 904-389-1104