Provider Demographics
NPI:1447532841
Name:CHEUY, CONSTANTINO (RPH)
Entity type:Individual
Prefix:
First Name:CONSTANTINO
Middle Name:
Last Name:CHEUY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8309 SOUTHSIDE BLVD
Mailing Address - Street 2:WALGREENS
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-672-1999
Mailing Address - Fax:
Practice Address - Street 1:8309 SOUTHSIDE BLVD
Practice Address - Street 2:WALGREENS
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-8403
Practice Address - Country:US
Practice Address - Phone:904-672-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist