Healthcare Provider Details

I. General information

NPI: 1619259694
Provider Name (Legal Business Name): DENNIS R SIBLEY II PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 N PONCE DELEON BLVD
ST AUGUSTINE FL
32084
US

IV. Provider business mailing address

11874 FITCHWOOD CIR
JACKSONVILLE FL
32258-4505
US

V. Phone/Fax

Practice location:
  • Phone: 904-810-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS46474
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: