Provider Demographics
NPI:1467025213
Name:LEGASPI, MARINELLA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARINELLA
Middle Name:
Last Name:LEGASPI
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 1:10668 ABBOT COVE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-8380
Mailing Address - Country:US
Mailing Address - Phone:904-480-6240
Mailing Address - Fax:
Practice Address - Street 1:11643 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-6604
Practice Address - Country:US
Practice Address - Phone:904-551-5870
Practice Address - Fax:904-619-6227
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS62152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS62152OtherFLORIDA BOARD OF PHARMACY