Provider Demographics
NPI:1013281872
Name:NIMRI, AMJAD K
Entity Type:Individual
Prefix:
First Name:AMJAD
Middle Name:K
Last Name:NIMRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11252 TURNBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2342
Mailing Address - Country:US
Mailing Address - Phone:904-755-6254
Mailing Address - Fax:
Practice Address - Street 1:7645 MERRILL RD STE 210
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-6574
Practice Address - Country:US
Practice Address - Phone:904-442-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-26
Last Update Date:2012-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist