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General NPI Number Information
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NPI Number | 1730385253
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Entity Type | Organization
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Legal Business Name | ATKINSON'S MART PHARMACY
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1994A KINGSLEY AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-4442
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Country | US
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Telephone | 904-298-0873
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Fax | 904-272-9680
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Provider Business Mailing Address
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Address Line | 1994A KINGSLEY AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-4442
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Country | US
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Telephone | 904-298-0873
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Fax | 904-272-9680
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Authorized Official
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Title or Position | OWNER
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Name | MR. KELLY WEBSTER DAVIS
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Credential |
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Telephone | 904-298-0873
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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 | PH17156
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License Number State | FL
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