MEDICARE: DR. CRISTINA VIDA 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	PS46483	FL

General Provider Information

NPI Number	:	1831436914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRISTINA VIDA PHARMD

Provider Business Mailing Address
First Line	:	11250 OLD SAINT AUGUSTINE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1088
Country	:	US
Telephone Number	:	904-262-4250
Fax Number	:	904-262-4035

Provider Business Practice Location Address
First Line	:	11250 OLD SAINT AUGUSTINE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1088
Country	:	US
Telephone Number	:	904-262-4250
Fax Number	:	904-262-4035

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

Provider Enumeration Date	:	01/10/2013
Last Update Date	:	01/10/2013

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