Provider Demographics
NPI:1477582716
Name:MATHENEY, JOANNA (RPH)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:MATHENEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 13TH AVE S
Mailing Address - Street 2:SUITE 117
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3230
Mailing Address - Country:US
Mailing Address - Phone:904-390-3601
Mailing Address - Fax:904-858-3053
Practice Address - Street 1:1370 13TH AVE S
Practice Address - Street 2:SUITE 117
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3230
Practice Address - Country:US
Practice Address - Phone:904-390-3601
Practice Address - Fax:904-858-3053
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist