Organization
JEFFERSON PHARMACY LLC
Active
Other names
Jefferson Pharmacy, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG JOHANSON (OWNER/MANAGER)
(904) 638-9515
Entity
Organization
Contact information
Practice address
2683 SAINT JOHNS BLUFF RD S STE 127, JACKSONVILLE, FL 32246-3765
(904) 516-8278
(904) 513-9293
Mailing address
2683 SAINT JOHNS BLUFF RD S STE 127, JACKSONVILLE, FL 32246-3765
(904) 516-8278
(904) 647-1510
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH28757
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149467
PK
—
Enumeration date
12/22/2014
Last updated
01/18/2017
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