Provider Demographics
NPI:1639311459
Name:CASTILLO, ELOISA JORDAN (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:ELOISA
Middle Name:JORDAN
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 BEVERLY BAY CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3536
Mailing Address - Country:US
Mailing Address - Phone:904-645-7532
Mailing Address - Fax:
Practice Address - Street 1:1363 MASSEY AVENUE
Practice Address - Street 2:
Practice Address - City:MAYPORT
Practice Address - State:FL
Practice Address - Zip Code:32228
Practice Address - Country:US
Practice Address - Phone:904-270-4205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL183700000X
183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician