Provider Demographics
NPI:1831102763
Name:AGAPE PHARMACY
Entity Type:Organization
Organization Name:AGAPE PHARMACY
Other - Org Name:DUVAL COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRTR OF PHCY
Authorized Official - Prefix:
Authorized Official - First Name:LEMORRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:904-253-2461
Mailing Address - Street 1:900 UNIVERSITY BLVD N
Mailing Address - Street 2:MC-96
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-9230
Mailing Address - Country:US
Mailing Address - Phone:904-253-1540
Mailing Address - Fax:904-924-1771
Practice Address - Street 1:120 KING ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-2410
Practice Address - Country:US
Practice Address - Phone:904-253-1540
Practice Address - Fax:904-253-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH194203336C0002X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026476800Medicaid
2006298OtherPK