Provider Demographics
NPI:1245565043
Name:ATCHERSON, GARLENE L (RPH)
Entity Type:Individual
Prefix:
First Name:GARLENE
Middle Name:L
Last Name:ATCHERSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:GARLENE
Other - Middle Name:D
Other - Last Name:ATCHERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:3736 JACOB COVE WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4585
Mailing Address - Country:US
Mailing Address - Phone:904-710-7831
Mailing Address - Fax:904-765-9686
Practice Address - Street 1:3736 JACOB COVE WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4585
Practice Address - Country:US
Practice Address - Phone:904-710-7831
Practice Address - Fax:904-765-9686
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist