Provider Demographics
NPI:1063015451
Name:ISAACSON, MARY JOCELYN (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JOCELYN
Last Name:ISAACSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:
Other - Last Name:ISAACSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:899 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-8917
Mailing Address - Country:US
Mailing Address - Phone:904-272-7801
Mailing Address - Fax:904-272-7804
Practice Address - Street 1:899 BLANDING BLVD
Practice Address - Street 2:(PHARMACY)
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065
Practice Address - Country:US
Practice Address - Phone:904-272-7801
Practice Address - Fax:904-272-7804
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS20996OtherFLORIDA STATE LICENSE