Provider Demographics
NPI:1780295949
Name:CARR, DANIEL JAMES (RPH)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:CARR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 PALM AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8432
Mailing Address - Country:US
Mailing Address - Phone:904-559-3504
Mailing Address - Fax:904-559-3506
Practice Address - Street 1:1301 PALM AVE STE 201
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8432
Practice Address - Country:US
Practice Address - Phone:904-559-3504
Practice Address - Fax:904-559-3506
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist