MEDICARE: FIRST COAST COMMUNITY DEVELOPMENT

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	3336C0002X	Clinic Pharmacy
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770276099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST COAST COMMUNITY DEVELOPMENT

Provider Business Mailing Address
First Line	:	4368 BOAT CLUB DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-1202
Country	:	US
Telephone Number	:	904-379-8383
Fax Number	:	904-358-5618

Provider Business Practice Location Address
First Line	:	525 N NEWNAN ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32202-3121
Country	:	US
Telephone Number	:	904-379-8383
Fax Number	:	904-358-5618

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHARLIE GRIFFIN
Credential	:
Telephone Number	:	904-866-7483

Provider Enumeration Date	:	06/01/2023
Last Update Date	:	06/11/2025

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Directions to “FIRST COAST COMMUNITY DEVELOPMENT ” Practice Location

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