MEDICARE: ERALD KOLA

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	PS59679	FL

General Provider Information

NPI Number	:	1558917781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERALD KOLA

Provider Business Mailing Address
First Line	:	14444 BEACH BLVD STE 6
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-2010
Country	:	US
Telephone Number	:	904-223-0423
Fax Number	:

Provider Business Practice Location Address
First Line	:	14444 BEACH BLVD STE 6
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-2010
Country	:	US
Telephone Number	:	904-223-0423
Fax Number	:

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

Provider Enumeration Date	:	08/13/2019
Last Update Date	:	08/13/2019

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Directions to “ ERALD KOLA ” Practice Location

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