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General NPI Number Information
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NPI Number | 1861761694
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Entity Type | Organization
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Legal Business Name | THE MEDIMIX, LLC
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Dates
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Enumeration Date | 12/22/2011
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 6820 SOUTHPOINT PKWY SUITE 9
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6276
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Country | US
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Telephone | 904-567-6334
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Fax | 866-745-6334
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Provider Business Mailing Address
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Address Line | 6820 SOUTHPOINT PKWY SUITE 9
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6276
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Country | US
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Telephone | 904-567-6334
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Fax | 866-745-6334
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Authorized Official
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Title or Position | MGR
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Name | JERON STOKES
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Credential |
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Telephone | 904-567-6334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH25863
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License Number State | FL
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