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General NPI Number Information
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NPI Number | 1467954438
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Entity Type | Organization
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Legal Business Name | DE2 LLC
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Dates
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Enumeration Date | 03/06/2018
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 6022 ATLANTIC BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32211-7503
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Country | US
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Telephone | 904-990-1054
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Fax | 904-990-1056
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Provider Business Mailing Address
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Address Line | 7707 MERRILL RD UNIT 8664
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City | JACKSONVILLE
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State | FL
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Zip | 32239-7728
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Country | US
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Telephone | 904-351-6434
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | KEVIN DUANE
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Credential |
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Telephone | 904-990-1054
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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 | 3336L0003X
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Taxonomy Name | Long Term Care 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 | PH31227
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License Number State | FL
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