MEDICARE: E PHARMACY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0002X	Clinic Pharmacy	PH 26904	FL

General Provider Information

NPI Number	:	1073921896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E PHARMACY, INC.

Provider Business Mailing Address
First Line	:	2624 ATLANTIC BLVD
Second Line	:	SUITE 3
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-3668
Country	:	US
Telephone Number	:	904-619-8616
Fax Number	:

Provider Business Practice Location Address
First Line	:	2624 ATLANTIC BLVD
Second Line	:	SUITE 3
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-3668
Country	:	US
Telephone Number	:	904-619-8616
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHEN E STAFFORD
Credential	:	R.PH.
Telephone Number	:	904-619-8616

Provider Enumeration Date	:	07/24/2014
Last Update Date	:	07/24/2014

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