Provider Demographics
NPI:1275191983
Name:UNIVERSITY PHARMACY OF JACKSONVILLE, INC
Entity type:Organization
Organization Name:UNIVERSITY PHARMACY OF JACKSONVILLE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:TAHER
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-535-8792
Mailing Address - Street 1:3901 UNIVERSITY BLVD S STE 237
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4390
Mailing Address - Country:US
Mailing Address - Phone:904-802-7177
Mailing Address - Fax:904-802-7096
Practice Address - Street 1:3901 UNIVERSITY BLVD S STE 237
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4390
Practice Address - Country:US
Practice Address - Phone:904-535-8792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH32128OtherCOMMUNITY RETAIL