Provider Demographics
NPI:1427695501
Name:KAPIDZIC, MUNEVERA (RPH)
Entity type:Individual
Prefix:
First Name:MUNEVERA
Middle Name:
Last Name:KAPIDZIC
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5647 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-2301
Mailing Address - Country:US
Mailing Address - Phone:904-384-4640
Mailing Address - Fax:904-384-3922
Practice Address - Street 1:5647 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-2301
Practice Address - Country:US
Practice Address - Phone:904-384-4640
Practice Address - Fax:904-384-3922
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-08
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist