Provider Demographics
NPI:1083951909
Name:FADIL, MEGAN MICHELLE (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:MICHELLE
Last Name:FADIL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:MICHELLE
Other - Last Name:HIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:12620 BEACH BLVD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7130
Mailing Address - Country:US
Mailing Address - Phone:904-564-3586
Mailing Address - Fax:904-564-4346
Practice Address - Street 1:12620 BEACH BLVD
Practice Address - Street 2:SUITE 12
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7130
Practice Address - Country:US
Practice Address - Phone:904-564-3586
Practice Address - Fax:904-564-4346
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL39058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist