MEDICARE: STEPHANIE COLEY PHARMD

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	PS28561	FL

General Provider Information

NPI Number	:	1619462496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE COLEY PHARMD

Provider Business Mailing Address
First Line	:	704 ABBY MIST DR
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-6900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7970 BAYBERRY RD STE 4
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7474
Country	:	US
Telephone Number	:	904-733-6033
Fax Number	:

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

Provider Enumeration Date	:	06/25/2018
Last Update Date	:	06/25/2018

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Directions to “ STEPHANIE COLEY PHARMD” Practice Location

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