Provider Demographics
NPI:1972491850
Name:PUBLIC SQUARE PHARMACY LLC
Entity type:Organization
Organization Name:PUBLIC SQUARE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-531-4556
Mailing Address - Street 1:2736 UNIVERSITY BLVD W STE 2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2170
Mailing Address - Country:US
Mailing Address - Phone:904-531-4556
Mailing Address - Fax:904-376-7718
Practice Address - Street 1:2736 UNIVERSITY BLVD W STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2170
Practice Address - Country:US
Practice Address - Phone:904-531-4556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy