Provider Demographics
NPI:1124470125
Name:HEBB, MARK STEPHEN JR (PHARMD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:STEPHEN
Last Name:HEBB
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7749 NORMANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-7657
Mailing Address - Country:US
Mailing Address - Phone:904-781-2509
Mailing Address - Fax:
Practice Address - Street 1:7749 NORMANDY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-7657
Practice Address - Country:US
Practice Address - Phone:904-781-2509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS54984OtherSTATE LICENSE