Provider Demographics
NPI:1891032678
Name:SPAGNUOLO, CHARLES (PHARM D)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:SPAGNUOLO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 MARSH LANDING PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5850
Mailing Address - Country:US
Mailing Address - Phone:904-273-7606
Mailing Address - Fax:904-273-7612
Practice Address - Street 1:670 MARSH LANDING PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-5850
Practice Address - Country:US
Practice Address - Phone:904-273-7606
Practice Address - Fax:904-273-7612
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49024183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist