Healthcare Provider Details

I. General information

NPI: 1548345945
Provider Name (Legal Business Name): RXPERT #1 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2177 KINGSLEY AVE SUITE 1
ORANGE PARK FL
32073-5199
US

IV. Provider business mailing address

2177 KINGSLEY AVE SUITE 1
ORANGE PARK FL
32073-5199
US

V. Phone/Fax

Practice location:
  • Phone: 904-272-1690
  • Fax: 904-272-1691
Mailing address:
  • Phone: 904-272-1690
  • Fax: 904-272-1691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPH21596
License Number StateFL

VIII. Authorized Official

Name: MR. JOHN K HURLEY
Title or Position: C.O.O.
Credential:
Phone: 904-272-1670