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General NPI Number Information
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NPI Number | 1922300565
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Entity Type | Organization
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Legal Business Name | JOSEPHS PHARMACY LLC
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Dates
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Enumeration Date | 12/02/2010
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 3130 N PACE BLVD
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City | PENSACOLA
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State | FL
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Zip | 32505-5140
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Country | US
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Telephone | 850-332-6998
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Fax | 850-466-2762
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Provider Business Mailing Address
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Address Line | 7125 ANNANDALE DR
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City | PENSACOLA
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State | FL
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Zip | 32526-8054
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Country | US
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Telephone | 850-332-6998
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | JAISON JOSEPH
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Credential |
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Telephone | 850-316-7604
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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 | PH25080
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License Number State | FL
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