Healthcare Provider Details

I. General information

NPI: 1871146696
Provider Name (Legal Business Name): EDWARD ALLARD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2019
Last Update Date: 07/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 JENKINS ST
SAINT AUGUSTINE FL
32086-5167
US

IV. Provider business mailing address

225 OLD VILLAGE CENTER CIR UNIT 4301
SAINT AUGUSTINE FL
32084-5807
US

V. Phone/Fax

Practice location:
  • Phone: 904-810-6823
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS59394
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: