Provider Demographics
NPI:1871198754
Name:MARON, DEBRA BREEANNA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:BREEANNA
Last Name:MARON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 RIVER RD APT 3
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-3077
Mailing Address - Country:US
Mailing Address - Phone:904-521-6965
Mailing Address - Fax:
Practice Address - Street 1:9509 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5431
Practice Address - Country:US
Practice Address - Phone:904-288-7865
Practice Address - Fax:904-288-7181
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59428183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist