Healthcare Provider Details

I. General information

NPI: 1205143856
Provider Name (Legal Business Name): ELIZABETH STOPHEL HOTCHKISS PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96076 LOFTON SQ CT
YULEE FL
32097
US

IV. Provider business mailing address

3360 SARA DR
JACKSONVILLE FL
32277-2575
US

V. Phone/Fax

Practice location:
  • Phone: 904-261-6500
  • Fax:
Mailing address:
  • Phone: 904-743-9340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16153
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: