Provider Demographics
NPI:1497282263
Name:FLORIDA A&M UNIVERSITY
Entity Type:Organization
Organization Name:FLORIDA A&M UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HIV RESIDENCY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOVAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:850-599-8656
Mailing Address - Street 1:872 W ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32310-6123
Mailing Address - Country:US
Mailing Address - Phone:850-606-8250
Mailing Address - Fax:
Practice Address - Street 1:872 W ORANGE AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32310-6123
Practice Address - Country:US
Practice Address - Phone:850-606-8250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH177323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy