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General NPI Number Information
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NPI Number | 1508966649
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Entity Type | Organization
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Legal Business Name | THE APOTHECARY AT MEMORIAL
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 03/30/2022
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Provider Practice Location Address
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Address Line | 3627 UNIVERSITY BLVD S
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4230
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Country | US
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Telephone | 904-702-6171
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Fax | 904-702-6004
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Provider Business Mailing Address
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Address Line | 3627 UNIVERSITY BLVD S
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4230
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Country | US
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Telephone | 904-702-6171
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Fax | 904-702-6004
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Authorized Official
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Title or Position | CFO
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Name | KEVIN MCKEOWN
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Credential |
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Telephone | 904-702-6573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number | PH 8064
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License Number State | FL
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