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General NPI Number Information
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NPI Number | 1962413500
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Entity Type | Organization
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Legal Business Name | PAVILION INFUSION THERAPY INC
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 03/16/2017
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Provider Practice Location Address
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Address Line | 3563 PHILIPS HWY STE 202
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5663
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Country | US
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Telephone | 904-202-5730
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Fax | 904-398-2225
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Provider Business Mailing Address
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Address Line | 3563 PHILIPS HWY STE 202
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5663
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Country | US
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Telephone | 904-202-5730
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Fax | 904-398-2225
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Authorized Official
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Title or Position | VP
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Name | CHRISTOPHER DURKIN
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Credential | FHFMA
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Telephone | 904-202-5887
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | PH13801
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License Number State | FL
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