Provider Demographics
NPI:1326011693
Name:FAIRLEY, PATRICK NEAL (RPH)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:NEAL
Last Name:FAIRLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 MARSH LANDING BLVD
Mailing Address - Street 2:APT 223
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2472
Mailing Address - Country:US
Mailing Address - Phone:904-270-4264
Mailing Address - Fax:904-270-4454
Practice Address - Street 1:2104 MASSEY AVENUE
Practice Address - Street 2:
Practice Address - City:NAVAL STATION MAYPORT
Practice Address - State:FL
Practice Address - Zip Code:32228
Practice Address - Country:US
Practice Address - Phone:904-270-4264
Practice Address - Fax:907-270-4454
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE08842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist