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General NPI Number Information
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NPI Number | 1821648122
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Entity Type | Individual
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Provider Name | ELIZABETH NICOLE RIDLEY PHARMD, BCPS, BCCCP
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Gender | Female
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | 655 W 8TH ST
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6511
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Country | US
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Telephone | 407-446-9211
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Fax |
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Provider Business Mailing Address
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Address Line | 10901 BURNT MILL RD APT 1802
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City | JACKSONVILLE
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State | FL
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Zip | 32256-2841
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH-0013317
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License Number State | OR
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