Organization
SUSAN DUBOSE
Active
Parent organization
WINN DIXIE 0144
Organization subpart
Yes
Provider details
NPI number
Legal business name
WINN DIXIE 0144
Authorized official
MISS LONNA WILKES PHARMD (PHARMACIST)
(904) 259-5868
Entity
Organization
Contact information
Practice address
1436 S 6TH ST, MACCLENNY, FL 32063-4623
(904) 259-5868
(904) 259-5275
Mailing address
1436 S 6TH ST, MACCLENNY, FL 32063-4623
(904) 259-5868
(904) 259-5275
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
EH11591
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101160000
—
FL
Enumeration date
08/14/2011
Last updated
08/14/2011
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