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General NPI Number Information
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NPI Number | 1568725984
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Entity Type | Organization
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Legal Business Name | NEPTUNE BEACH PHARMACY LLC
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 1529 ATLANTIC BLVD
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City | NEPTUNE BEACH
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State | FL
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Zip | 32266
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Country | US
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Telephone | 904-685-4919
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Fax | 904-685-2390
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Provider Business Mailing Address
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Address Line | 1529 ATLANTIC BLVD
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City | NEPTUNE BEACH
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State | FL
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Zip | 32266
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Country | US
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Telephone | 904-422-4485
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Fax | 904-685-2390
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Authorized Official
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Title or Position | OWNER
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Name | EDET U SAMPSON
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Credential | R.P.H
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Telephone | 904-685-4919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number |
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License Number State | FL
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