Provider Demographics
NPI:1407879372
Name:PAXON PRESCRIPTION CENTER INC
Entity Type:Organization
Organization Name:PAXON PRESCRIPTION CENTER INC
Other - Org Name:O'STEENS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:TOOLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:904-388-0514
Mailing Address - Street 1:757 EDGEWOOD AVE N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254-3013
Mailing Address - Country:US
Mailing Address - Phone:904-388-0514
Mailing Address - Fax:904-388-2596
Practice Address - Street 1:757 EDGEWOOD AVE N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-3013
Practice Address - Country:US
Practice Address - Phone:904-388-0514
Practice Address - Fax:904-388-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH5613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1012563OtherNABP
FL100911701Medicaid
FL100911700Medicaid
FLAP0200612OtherDEA LICENSE
FL100911701Medicaid
FL100911701Medicaid