Healthcare Provider Details

I. General information

NPI: 1528169372
Provider Name (Legal Business Name): EDDIE JAMES HUKLE RPH, PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 SOUTH MARION AVE
LAKE CITY FL
32056-9000
US

IV. Provider business mailing address

19319 NW 230 STREET
HIGH SPRINGS FL
32643
US

V. Phone/Fax

Practice location:
  • Phone: 180-030-8838
  • Fax:
Mailing address:
  • Phone: 180-030-8838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14792
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: