Provider Demographics
NPI:1467471110
Name:OSSIS APOTHECARY
Entity Type:Organization
Organization Name:OSSIS APOTHECARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-641-5555
Mailing Address - Street 1:9852 BAYMEADOWS ROAD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7962
Mailing Address - Country:US
Mailing Address - Phone:904-641-5555
Mailing Address - Fax:904-646-0278
Practice Address - Street 1:9852 BAYMEADOWS RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7962
Practice Address - Country:US
Practice Address - Phone:904-641-5555
Practice Address - Fax:904-646-0278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH2679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty