Provider Demographics
NPI:1689801037
Name:WINGATE, STUART LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:LEE
Last Name:WINGATE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10640 ANTHEM WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4081
Mailing Address - Country:US
Mailing Address - Phone:904-910-9917
Mailing Address - Fax:
Practice Address - Street 1:2104 MASSEY AVE/NAVAL STATION
Practice Address - Street 2:
Practice Address - City:MAYPORT
Practice Address - State:FL
Practice Address - Zip Code:32228-0148
Practice Address - Country:US
Practice Address - Phone:904-641-1207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 23358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist