Provider Demographics
NPI:1932705548
Name:DAO, MYLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MYLE
Middle Name:
Last Name:DAO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5634 MERRILL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-3306
Mailing Address - Country:US
Mailing Address - Phone:904-743-0109
Mailing Address - Fax:904-743-0192
Practice Address - Street 1:5634 MERRILL RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-3306
Practice Address - Country:US
Practice Address - Phone:904-743-0109
Practice Address - Fax:904-743-0192
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS52190OtherPHARMACIST LICENSE NUMBER