Provider Demographics
NPI:1033582937
Name:HORVATH, JOHN ANDREW JR
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANDREW
Last Name:HORVATH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 PINE ST
Mailing Address - Street 2:APT B
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6477
Mailing Address - Country:US
Mailing Address - Phone:315-749-5911
Mailing Address - Fax:
Practice Address - Street 1:1700 N MONROE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5535
Practice Address - Country:US
Practice Address - Phone:850-222-8992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS52752OtherFL PHARMACY LICENSE