Healthcare Provider Details

I. General information

NPI: 1144528266
Provider Name (Legal Business Name): JOHN MARK GIONET R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 N MARINE BLVD
JACKSONVILLE NC
28540-6142
US

IV. Provider business mailing address

622 N MARINE BLVD
JACKSONVILLE NC
28540-6142
US

V. Phone/Fax

Practice location:
  • Phone: 910-455-2911
  • Fax: 910-937-1802
Mailing address:
  • Phone: 910-455-2911
  • Fax: 910-937-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16158
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: