Organization
DE2 LLC
Active
Other names
Panama Pharmacy #2, Panama Pharmacy at eMed
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN DUANE (MANAGING MEMBER)
(904) 990-1054
Entity
Organization
Contact information
Practice address
6022 ATLANTIC BLVD, JACKSONVILLE, FL 32211-7503
(904) 990-1054
(904) 990-1056
Mailing address
7707 MERRILL RD UNIT 8664, JACKSONVILLE, FL 32239-7728
(904) 351-6434
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH31227
FL
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025153200
—
FL
01
—
2176263
PK
—
Enumeration date
03/06/2018
Last updated
11/07/2022
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