Provider Demographics
NPI:1841854213
Name:SHUFORD, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SHUFORD
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 1:3205 TURTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5411
Mailing Address - Country:US
Mailing Address - Phone:904-347-7345
Mailing Address - Fax:
Practice Address - Street 1:300 HEALTH PARK BLVD STE 1002
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3702
Practice Address - Country:US
Practice Address - Phone:904-824-4556
Practice Address - Fax:904-810-6823
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist