Provider Demographics
NPI:1083995161
Name:ROYSTON, DANA CALLANDRA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:CALLANDRA
Last Name:ROYSTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 SEASCAPE WAY
Mailing Address - Street 2:APT 103
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0639
Mailing Address - Country:US
Mailing Address - Phone:305-331-7939
Mailing Address - Fax:
Practice Address - Street 1:4715 HODGES BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2216
Practice Address - Country:US
Practice Address - Phone:904-992-4643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43992183500000X
VA0202208790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist