Provider Demographics
NPI:1245510734
Name:AUTRY, JAMES M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:AUTRY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 REE ST
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-1453
Mailing Address - Country:US
Mailing Address - Phone:352-745-6707
Mailing Address - Fax:
Practice Address - Street 1:2094 W US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4720
Practice Address - Country:US
Practice Address - Phone:386-755-0313
Practice Address - Fax:386-755-5994
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist