Provider Demographics
NPI:1689682148
Name:DC STILES, INC
Entity Type:Organization
Organization Name:DC STILES, INC
Other - Org Name:PRESTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STILES-YOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:904-725-1616
Mailing Address - Street 1:6022 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211
Mailing Address - Country:US
Mailing Address - Phone:904-724-0424
Mailing Address - Fax:904-723-2671
Practice Address - Street 1:6022 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211
Practice Address - Country:US
Practice Address - Phone:904-724-0424
Practice Address - Fax:904-723-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH6421OtherCOMMUNITY PHARMACY LIC.
1004960OtherNABP
103ZMedicare ID - Type Unspecified
FL1032390001Medicare NSC
390001Medicare UPIN