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General NPI Number Information
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NPI Number | 1063903672
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Entity Type | Organization
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Legal Business Name | NORTHEAST FLORIDA HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 05/21/2018
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 1205 S WOODLAND BLVD STE 5
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City | DELAND
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State | FL
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Zip | 32720-7464
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Country | US
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Telephone | 386-202-6025
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Fax | 386-269-1847
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Provider Business Mailing Address
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Address Line | 1205 S WOODLAND BLVD
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City | DELAND
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State | FL
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Zip | 32720-7466
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Country | US
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Telephone | 386-202-6025
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Fax | 386-269-1847
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Authorized Official
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Title or Position | CEO
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Name | LAURIE ASBURY
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Credential |
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Telephone | 386-202-6025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State | FL
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