Organization
MED EX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRIS BRANTLEY (PHARMACY ADMINISTRATOR)
(904) 739-1309
Entity
Organization
Contact information
Practice address
6500 CRILL AVE, PALATKA, FL 32177-6807
(904) 739-1309
(904) 739-1310
Mailing address
PO BOX 10890, JACKSONVILLE, FL 32247-0890
(904) 739-1309
(904) 739-1310
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
ME54477
FL
Other
Enumeration date
03/16/2009
Last updated
03/16/2009
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