Provider Demographics
NPI:1508966649
Name:THE APOTHECARY AT MEMORIAL
Entity Type:Organization
Organization Name:THE APOTHECARY AT MEMORIAL
Other - Org Name:HCA FLORIDA MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEOWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-702-6573
Mailing Address - Street 1:3627 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4230
Mailing Address - Country:US
Mailing Address - Phone:904-702-6171
Mailing Address - Fax:904-702-6004
Practice Address - Street 1:3627 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4230
Practice Address - Country:US
Practice Address - Phone:904-702-6171
Practice Address - Fax:904-702-6004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HEALTHCARE GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-25
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 8064261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109647800Medicaid