Provider Demographics
NPI:1689099319
Name:EHE, EDJONA KODJOVI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EDJONA
Middle Name:KODJOVI
Last Name:EHE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:ED
Other - Middle Name:
Other - Last Name:EHE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:5972 UNIVERSITY BLVD W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4912
Mailing Address - Country:US
Mailing Address - Phone:904-248-0689
Mailing Address - Fax:
Practice Address - Street 1:5972 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4912
Practice Address - Country:US
Practice Address - Phone:904-248-0689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist