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General NPI Number Information
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NPI Number | 1407154347
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Entity Type | Organization
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Legal Business Name | EGLE ENTERPRISES INC
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Dates
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Enumeration Date | 03/01/2011
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Last Update Date | 03/01/2011
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Provider Practice Location Address
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Address Line | 6055 SAINT AUGUSTINE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2104
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Country | US
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Telephone | 904-739-8101
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Fax |
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Provider Business Mailing Address
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Address Line | 5890 SW 43RD STREET RD
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City | OCALA
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State | FL
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Zip | 34474-9554
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Country | US
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Telephone | 904-739-8101
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAHESH L PATEL
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Credential |
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Telephone | 904-739-8101
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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 | PH25302
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License Number State | FL
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