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General NPI Number Information
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NPI Number | 1831700855
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Entity Type | Organization
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Legal Business Name | KINGSLEY RX LLC
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Dates
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Enumeration Date | 08/13/2020
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 1542 KINGSLEY AVE STE 142
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City | ORANGE PARK
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State | FL
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Zip | 32073-4547
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Country | US
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Telephone | 904-409-1337
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Fax | 904-375-1362
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Provider Business Mailing Address
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Address Line | 1542 KINGSLEY AVE STE 142
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City | ORANGE PARK
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State | FL
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Zip | 32073-4547
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Country | US
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Telephone | 904-409-1337
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Fax | 904-375-1362
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MADELINE DEFALCO
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Credential | PHARMACIST
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Telephone | 904-409-1337
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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 |
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License Number State |
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