MEDICARE: GARLENE L. ATCHERSON R.PH.

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	183500000X	Pharmacist	PS24040	FL

General Provider Information

NPI Number	:	1245565043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARLENE L. ATCHERSON R.PH.

Provider Business Mailing Address
First Line	:	3736 JACOB COVE WAY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-4585
Country	:	US
Telephone Number	:	904-710-7831
Fax Number	:	904-765-9686

Provider Business Practice Location Address
First Line	:	3736 JACOB COVE WAY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-4585
Country	:	US
Telephone Number	:	904-710-7831
Fax Number	:	904-765-9686

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2009
Last Update Date	:	10/12/2009

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