Healthcare Provider Details

I. General information

NPI: 1922025600
Provider Name (Legal Business Name): RXPERT 1 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2177 KINGSLEY AVE
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 TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH21596
License Number StateFL

VIII. Authorized Official

Name: JANET SAWICKI
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 904-272-1690