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General NPI Number Information
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NPI Number | 1619223351
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Entity Type | Organization
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Legal Business Name | NORTH MAIN PHARMACY
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 02/21/2013
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Provider Practice Location Address
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Address Line | 12405 N MAIN ST STE 3
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City | JACKSONVILLE
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State | FL
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Zip | 32218-2609
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Country | US
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Telephone | 904-696-0265
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Fax |
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Provider Business Mailing Address
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Address Line | 12405 NORTH MAIN STREET SUITE 3
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City | JACKSONVILLE
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State | FL
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Zip | 32218
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Country | US
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Telephone | 904-696-0265
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SANJAY RAMCHARAN
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Credential |
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Telephone | 904-696-0265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH26273
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License Number State | FL
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