Provider Demographics
NPI:1295072270
Name:MAYER, VICTORIA ANNE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANNE
Last Name:MAYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4495 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-3375
Mailing Address - Country:US
Mailing Address - Phone:904-388-1303
Mailing Address - Fax:904-388-4713
Practice Address - Street 1:4495 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-3375
Practice Address - Country:US
Practice Address - Phone:904-388-1303
Practice Address - Fax:904-388-4713
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0033234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist