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General NPI Number Information
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NPI Number | 1457630519
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Entity Type | Organization
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Legal Business Name | QUALITY SPECIALTY PHARMACY OF JACKSONVILLE INC
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Dates
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Enumeration Date | 08/08/2011
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 6680 POWERS AVE UNIT 110
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2889
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Country | US
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Telephone | 904-365-5500
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Fax | 904-365-5501
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Provider Business Mailing Address
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Address Line | P.O. BOX 16159
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City | TEMPLE TERRACE
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State | FL
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Zip | 33682
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Country | US
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Telephone | 904-365-5500
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Fax | 904-365-5501
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Authorized Official
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Title or Position | OWNER
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Name | SOFIA AXEN
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Credential |
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Telephone | 718-648-2952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH25472
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License Number State | FL
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