=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831102763
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGAPE PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2006
-----------------------------------------------------
Last Update Date | 07/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 KING ST
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32204-2410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-253-1540
-----------------------------------------------------
Fax | 904-253-1890
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 UNIVERSITY BLVD N MC-96
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32211-9230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-253-1540
-----------------------------------------------------
Fax | 904-924-1771
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRTR OF PHCY
-----------------------------------------------------
Name | LEMORRIS PRIER
-----------------------------------------------------
Credential | PHARM.D
-----------------------------------------------------
Telephone | 904-253-2461
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0002X
-----------------------------------------------------
Taxonomy Name | Clinic Pharmacy
-----------------------------------------------------
License Number | PH19420
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------