Organization
ATKINSON'S MART, INC.
Active
Other names
ATKINSON'S HOSPITAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN WILEY DAVIS (OWNER)
(904) 298-0873
Entity
Organization
Contact information
Practice address
1994 KINGSLEY AVE, ORANGE PARK, FL 32073-4442
(904) 298-0873
Mailing address
1994 KINGSLEY AVE STE A, ORANGE PARK, FL 32073-4465
(904) 298-0873
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH17156
FL
3336C0004X
Compounding Pharmacy
PH28421
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101585100
—
FL
Enumeration date
12/01/2006
Last updated
02/02/2015
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