Provider Demographics
NPI:1790227254
Name:ZAVALA, JOE LOZANO III (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:LOZANO
Last Name:ZAVALA
Suffix:III
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 1:3835 MILLPOINT DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8935
Mailing Address - Country:US
Mailing Address - Phone:912-704-8044
Mailing Address - Fax:
Practice Address - Street 1:10500 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6209
Practice Address - Country:US
Practice Address - Phone:904-288-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist