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NPI Code Detail

MEDICARE: EMMA JANE CLEGG PHARMD

MEDICARE: EMMA JANE CLEGG PHARMD
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
1183500000XPharmacist58119FL

General Provider Information

NPI Number : 1124507512
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMA JANE CLEGG PHARMD
Provider Business Mailing Address
First Line : 9310 SOUTHPARK CENTER LOOP
Second Line :
City : ORLANDO
State : FL
Zip : 32819-8634
Country : US
Telephone Number : 407-845-6774
Fax Number :
Provider Business Practice Location Address
First Line : 9310 SOUTHPARK CENTER LOOP
Second Line :
City : ORLANDO
State : FL
Zip : 32819-8634
Country : US
Telephone Number : 407-845-6774
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2018
Last Update Date : 03/16/2023

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