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General NPI Number Information
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NPI Number | 1346630761
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Entity Type | Organization
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Legal Business Name | COMPLETE 180
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Dates
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Enumeration Date | 01/24/2015
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Last Update Date | 01/24/2015
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Provider Practice Location Address
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Address Line | 4750 SOUTEL DR SUITE &
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City | JACKSONVILLE
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State | FL
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Zip | 32208-8510
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Country | US
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Telephone | 352-255-2695
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 57411
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City | JACKSONVILLE
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State | FL
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Zip | 32241-7411
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Country | US
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Telephone | 352-255-2695
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERIKA JASPER
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Credential | PHARM. D
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Telephone | 352-255-2695
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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 | PS36762
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PU6243
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 55903
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | PU6243
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License Number State | FL
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