MEDICARE: MR. TODD TROXELL 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
1	183500000X	Pharmacist	PS28723	FL

General Provider Information

NPI Number	:	1689600710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TODD TROXELL RPH

Provider Business Mailing Address
First Line	:	14546 SAINT AUGUSTINE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5468
Country	:	US
Telephone Number	:	904-821-6690
Fax Number	:	904-821-6692

Provider Business Practice Location Address
First Line	:	14546 ST. AUGUSTINE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5469
Country	:	US
Telephone Number	:	904-821-6690
Fax Number	:	904-821-6692

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	07/08/2007

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