Provider Demographics
NPI:1518930536
Name:NAVAL HOSPITAL NAS JACKSONVILLE PHARMACY DEPT
Entity Type:Organization
Organization Name:NAVAL HOSPITAL NAS JACKSONVILLE PHARMACY DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANWULI
Authorized Official - Middle Name:AYO
Authorized Official - Last Name:MADUAKA-CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-542-7406
Mailing Address - Street 1:8195 CONCORD BLVD E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-2831
Mailing Address - Country:US
Mailing Address - Phone:904-765-2812
Mailing Address - Fax:
Practice Address - Street 1:2080 CHILD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214-5005
Practice Address - Country:US
Practice Address - Phone:904-542-7406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19012286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital