Provider Demographics
NPI:1871015016
Name:USZTOK, SHANNON BLIZZARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:BLIZZARD
Last Name:USZTOK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:SUMNER
Other - Last Name:BLIZZARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:655 WEST 8TH STREET
Mailing Address - Street 2:PHARMACY, #83
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209
Mailing Address - Country:US
Mailing Address - Phone:904-244-0354
Mailing Address - Fax:
Practice Address - Street 1:655 WEST 8TH STREET
Practice Address - Street 2:PHARMACY, #83
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209
Practice Address - Country:US
Practice Address - Phone:904-244-0354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist