=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689682148
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DC STILES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2006
-----------------------------------------------------
Last Update Date | 03/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6022 ATLANTIC BLVD
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-724-0424
-----------------------------------------------------
Fax | 904-723-2671
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6022 ATLANTIC BLVD
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-724-0424
-----------------------------------------------------
Fax | 904-723-2671
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST VICE PRESIDENT
-----------------------------------------------------
Name | MS. DENISE A STILES-YOUNT
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 904-725-1616
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------