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NPI Code Detail

MEDICARE: FADRA HENRY RPH.

MEDICARE: FADRA HENRY 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
1183500000XPharmacist18769FL

General Provider Information

NPI Number : 1255304994
Entity Type Code : Individual
Provider Name (Legal Business Name) : FADRA HENRY RPH.
Provider Business Mailing Address
First Line : 3048 POSTMILL DR
Second Line :
City : ORANGE PARK
State : FL
Zip : 32073-7688
Country : US
Telephone Number : 904-778-0855
Fax Number :
Provider Business Practice Location Address
First Line : 1280 CHILD ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32214-0001
Country : US
Telephone Number : 904-542-7408
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2006
Last Update Date : 07/08/2007

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