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General NPI Number Information
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NPI Number | 1730498288
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Entity Type | Organization
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Legal Business Name | BEACHES PHARMACY LLC
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Dates
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Enumeration Date | 10/01/2010
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Last Update Date | 10/01/2010
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Provider Practice Location Address
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Address Line | 4717 SAN JUAN AVE UNIT 1
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City | JACKSONVILLE
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State | FL
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Zip | 32210-3229
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Country | US
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Telephone | 850-545-7646
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Fax |
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Provider Business Mailing Address
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Address Line | 4320 DEERWOOD LAKE PKWY STE 101-211
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1177
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | SAMUEL MAYO
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Credential | PHARMD, RPH
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Telephone | 850-545-7646
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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 | PS43165
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License Number State | FL
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