Organization
LANE AVENUE PHARMACY INC
Active
Other names
LANE AVENUE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
FELIX OBASUYI RPH (OWNER / PHARMACIST)
(904) 693-6633
Entity
Organization
Contact information
Practice address
1233 LANE AVE S, STE 9, JACKSONVILLE, FL 32205-6284
(904) 693-6633
(904) 693-6684
Mailing address
2595 WATERMILL DR, ORANGE PARK, FL 32073-1621
(904) 693-6633
(904) 693-6684
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH23097
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
032420500
—
FL
01
—
1031412
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/08/2008
Last updated
06/14/2010
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