Provider Demographics
NPI:1518230358
Name:EUBANKS, JIMMY D JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:D
Last Name:EUBANKS
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 OAK SHORE DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-2929
Mailing Address - Country:US
Mailing Address - Phone:850-733-8262
Mailing Address - Fax:
Practice Address - Street 1:1533 OAK SHORE DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-2929
Practice Address - Country:US
Practice Address - Phone:850-733-8262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS32204OtherFLORIDA STATE PHARMACIST LICENSE NUMBER