Organization
LIQUID LOGIC RX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANTONIETTA GUZMAN (OFFICE MANAGER)
(904) 374-0260
Entity
Organization
Contact information
Practice address
5105 BOWDEN RD, JACKSONVILLE, FL 32216-5907
(904) 374-0294
Mailing address
5105 BOWDEN RD, JACKSONVILLE, FL 32216-5907
(904) 374-0294
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
207L00000X
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
258429800
—
FL
Enumeration date
11/02/2016
Last updated
11/02/2016
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