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NPI Code Detail

MEDICARE: STACY CHAO

MEDICARE: STACY CHAO
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
1183500000XPharmacistPS45075FL

General Provider Information

NPI Number : 1942828512
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY CHAO
Provider Business Mailing Address
First Line : 4446 HENDRICKS AVE STE 408
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-6369
Country : US
Telephone Number : 904-551-5094
Fax Number : 904-527-1244
Provider Business Practice Location Address
First Line : 3851 EMERSON ST STE 13
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-4756
Country : US
Telephone Number : 904-551-5094
Fax Number : 904-527-1244
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2020
Last Update Date : 07/10/2020

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Directions to “ STACY CHAO ” Practice Location

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