=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477834885
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DORIAN J. AUSTIN PHARM.,D., R.PH.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2011
-----------------------------------------------------
Last Update Date | 09/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5108 NORWOOD AVE
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32208-5032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-768-4491
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 654 CASSAT AVE
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32205-4717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-693-3321
-----------------------------------------------------
Fax | 904-693-9694
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | FLPS47057
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------