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NPI Code Detail

MEDICARE: MRS. BREONNA OXENDINE RPH

MEDICARE: MRS. BREONNA OXENDINE RPH
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
1183500000XPharmacistPS59793FL

General Provider Information

NPI Number : 1235787037
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BREONNA OXENDINE RPH
Provider Business Mailing Address
First Line : 2914 LAUREL SPRINGS DR
Second Line :
City : GREEN COVE SPRINGS
State : FL
Zip : 32043-7270
Country : US
Telephone Number : 386-336-2475
Fax Number :
Provider Business Practice Location Address
First Line : 1305 N ORANGE AVE STE 120-123
Second Line :
City : GREEN COVE SPRINGS
State : FL
Zip : 32043-2547
Country : US
Telephone Number : 904-284-5677
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2019
Last Update Date : 11/22/2024

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Directions to “ MRS. BREONNA OXENDINE RPH” Practice Location

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