MEDICARE: MRS. NELLIE N BORBA-NASSIROU 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	PS33815	FL

General Provider Information

NPI Number	:	1780750521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NELLIE N BORBA-NASSIROU RPH

Provider Business Mailing Address
First Line	:	5587 GLASGOW HILLS LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-2510
Country	:	US
Telephone Number	:	904-260-0004
Fax Number	:

Provider Business Practice Location Address
First Line	:	6817 SOUTHPOINT PKWY STE 1702
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6298
Country	:	US
Telephone Number	:	904-296-9145
Fax Number	:

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

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	07/08/2007

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Directions to “ MRS. NELLIE N BORBA-NASSIROU RPH” Practice Location

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