Provider Demographics
NPI:1396036562
Name:DORBU, EMMANUEL S (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:S
Last Name:DORBU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 UNIVERSITY BLVD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-5529
Mailing Address - Country:US
Mailing Address - Phone:904-744-0104
Mailing Address - Fax:904-744-0105
Practice Address - Street 1:939 UNIVERSITY BLVD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5529
Practice Address - Country:US
Practice Address - Phone:904-744-0104
Practice Address - Fax:904-744-0105
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist