Provider Demographics
NPI:1063814499
Name:BLACKMON, GINGER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GINGER
Middle Name:
Last Name:BLACKMON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 A C SKINNER PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6932
Mailing Address - Country:US
Mailing Address - Phone:904-519-2720
Mailing Address - Fax:904-519-2721
Practice Address - Street 1:7015 A C SKINNER PKWY STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6932
Practice Address - Country:US
Practice Address - Phone:904-519-2720
Practice Address - Fax:904-519-2721
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist