=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538563580
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORIDA A AND M UNIVERSITY COLLEGE OF PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2014
-----------------------------------------------------
Last Update Date | 10/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2050 ART MUSEUM DR SUITE 200
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32207-2595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-391-3900
-----------------------------------------------------
Fax | 904-391-3915
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2050 ART MUSEUM DR SUITE 200
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32207-2595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-391-3900
-----------------------------------------------------
Fax | 904-391-3915
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIVISION DIRECTOR
-----------------------------------------------------
Name | DR. FRANK S EMANUEL
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 904-391-3901
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 13024
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | PU379
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------