MEDICARE: LUMA YAZJI

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	PS39826	FL

General Provider Information

NPI Number	:	1538769211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUMA YAZJI

Provider Business Mailing Address
First Line	:	11900 ATLANTIC BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-2920
Country	:	US
Telephone Number	:	904-641-7551
Fax Number	:

Provider Business Practice Location Address
First Line	:	10991 SAN JOSE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-6675
Country	:	US
Telephone Number	:	904-260-4407
Fax Number	:

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

Provider Enumeration Date	:	10/30/2020
Last Update Date	:	10/30/2020

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