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General NPI Number Information
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NPI Number | 1316557507
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Entity Type | Individual
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Provider Name | LAUREN MEAGAN KUCERA
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Gender | Female
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 12/27/2020
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Provider Practice Location Address
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Address Line | 155 BARTRAM MARKET DR
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City | JACKSONVILLE
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State | FL
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Zip | 32259-4581
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Country | US
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Telephone | 904-260-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 13050 GRAN BAY PKWY UNIT 619
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City | JACKSONVILLE
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State | FL
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Zip | 32258-4521
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Country | US
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Telephone | 850-503-5261
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS61180
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License Number State | FL
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