Healthcare Provider Details

I. General information

NPI: 1700481579
Provider Name (Legal Business Name): JUCHI HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 WATSON RD
SAINT AUGUSTINE FL
32086-1874
US

IV. Provider business mailing address

46 WATSON RD
SAINT AUGUSTINE FL
32086-1874
US

V. Phone/Fax

Practice location:
  • Phone: 904-797-6774
  • Fax: 904-797-2695
Mailing address:
  • Phone: 904-797-6774
  • Fax: 904-797-2695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS34788
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: