Provider Demographics
NPI:1265564249
Name:DJOKOTO, EMMANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:
Last Name:DJOKOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 CASCADIA CT
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3417
Mailing Address - Country:US
Mailing Address - Phone:904-374-9334
Mailing Address - Fax:904-374-9309
Practice Address - Street 1:5800 BEACH BLVD STE 105
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5180
Practice Address - Country:US
Practice Address - Phone:904-374-9334
Practice Address - Fax:904-374-9309
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist