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Organization

STATE OF FLORIDA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DEAN EDWARD WILLIS DRPH (DIRECTOR)
(904) 791-1559
Entity
Organization

Contact information

Practice address
1217 N PEARL ST, JACKSONVILLE, FL 32202-3926
(904) 791-1559
Mailing address
1217 N PEARL ST, JACKSONVILLE, FL 32202-3926
(904) 791-1559

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
DI003429
FL

Other

Enumeration date
01/30/2014
Last updated
01/30/2014
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