MAYO CLINIC JACKSONVILLE (NPI# 1558350413) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558350413 |
| Entity Type | Organization |
| Organization Name | MAYO CLINIC JACKSONVILLE |
| Other Organization Name | MAYO PHARMACY |
| Practice Address |
4500 San Pablo Rd S Jacksonville FL 32224-1865 |
| Practice Telephone | 9049537355 |
| Practice Fax Number | 9049531768 |
| Mailing Telephone | 9049537355 |
| Mailing Fax Number | 9049531768 |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2015-05-18 |
| Authorized Official Name | CHRISTINA ZORN (CHIEF ADMINISTRATIVE OFFICER) |
| Authorized Official Telephone | 9049532146 |
| Is Organization Subpart | Y |
| Parent Organization Name | MAYO CLINIC JACKSONVILLE |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 333600000X | Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | LICENSE NUMBER | PH14369 | 01 |
| FL | 009241600 | 05 |
| Other Name | Type Code |
|---|---|
| Mayo Pharmacy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265097513 | Mayo Clinic Jacksonville | Ambulance | 13970 Zumbro Dr, Jacksonville, FL 32224 | 2019-05-02 |
| 1578037891 | Mayo Clinic Jacksonville | Durable Medical Equipment & Medical Supplies | 7826 Ozark Dr, Jacksonville, FL 32256-5839 | 2019-01-21 |
| 1790772317 | Mayo Clinic Jacksonville | Durable Medical Equipment & Medical Supplies | 4500 San Pablo Road, Jacksonville, FL 32224-1865 | 2005-09-29 |
| 1174143986 | Mayo Clinic Jacksonville | Clinic/Center | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-04-22 |
| 1871054106 | Mayo Clinic Jacksonville | Clinic/Center | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2019-03-28 |
| 1962499079 | Mayo Clinic Jacksonville | Clinic/Center | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2005-10-04 |
| 1285621631 | Mayo Clinic Jacksonville | Clinical Medical Laboratory | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2005-09-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MAYO CLINIC JACKSONVILLE (A NONPROFIT CORPORATION) | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 |
| Street Address |
4500 SAN PABLO RD S |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32224-1865 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891799136 | Richard Clarke Agnew | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2005-06-01 |
| 1427657964 | Brianna Iannarelli | Nurse Anesthetist, Certified Registered | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-10-24 |
| 1538768981 | Heather Anne Dahlen | Nurse Practitioner | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-10-17 |
| 1578161717 | Szilvia Fortner | Nurse Practitioner | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-10-10 |
| 1265049464 | Carolyn Gonzalez | Nurse Practitioner | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-09-30 |
| 1467065748 | Ifeloluwa A Olutola | Family Medicine | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-26 |
| 1366055568 | Krina Dipak Vyas | Pharmacist | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-26 |
| 1356954911 | Haleigh Diane Shelton | Pharmacist | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-24 |
| 1215548805 | Victoria Zeilinger Reams | Pharmacist | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-16 |
| 1558971382 | Rachel Marie Hannon | Nurse Practitioner | 4500 San Pablo Rd S, Jacksonville, FL 32224-1865 | 2020-08-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356974372 | Noelle Parker | Specialist/Technologist | 1 Unf Drivve, Jacksonville, FL 32224 | 2020-02-18 |
| 1124685102 | Charcy Rene Stiller | Specialist/Technologist | 1 Unf Dr., Jacksonville, FL 32224 | 2019-05-24 |
| 1265097513 | Mayo Clinic Jacksonville | Ambulance | 13970 Zumbro Dr, Jacksonville, FL 32224 | 2019-05-02 |
| 1639681471 | Brigantti Anesthesia & Spine Care | Clinic/Center | 1361 13th Ave South Suite #210, Jacksonville, FL 32224 | 2017-11-02 |
| 1093240061 | Beric Emilio Berlioz | Anesthesiology | 4500 San Pablo Rd S # J, Jacksonville, FL 32224 | 2017-04-26 |
| 1609240746 | Matthew James Dailey | Nurse Anesthetist, Certified Registered | 2500 San Pablo Rd S, Jacksonville, FL 32224 | 2015-11-29 |
| 1003299603 | Upscale Personal Care Home | Assisted Living Facility | 4375 Autumn River Road, Jacksonville, FL 32224 | 2015-07-01 |
| 1629459375 | Bellanid Fonseca | Social Worker | 3694 Summerlin Ln E, Jacksonville, FL 32224 | 2015-06-17 |
| 1164840500 | Nicholas Scotto | Physical Therapist | 11555 Central Pkwy Ste 1104, Jacksonville, FL 32224 | 2014-04-02 |
| 1497093454 | Quicker Care Urgent Care | Point of Service | 13770 Beach Blvd., Unit # 4, Jacksonville, FL 32224 | 2013-01-27 |
| Find all providers in zip 32224 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467954438 | De2 LLC | Pharmacy | 2624 Atlantic Blvd Ste 3, Jacksonville, FL 32207-3633 | 2018-03-06 |
| 1174037063 | Banyanites - 2 LLC | Pharmacy | 11048 Baymeadows Rd Unit 5, Jacksonville, FL 32256-9583 | 2017-11-30 |
| 1538600424 | Can Community Health Inc. | Pharmacy | 4615 Philips Hwy, Suite 3, Jacksonville, FL 32207-9506 | 2017-03-13 |
| 1871039701 | An&u Inc | Pharmacy | 1729 S Jackson St, Jacksonville, TX 75766-5832 | 2017-01-17 |
| 1114479821 | Trucare Ltc, LLC | Pharmacy | 2671 Huffman Blvd, Jacksonville, FL 32246-4056 | 2016-10-28 |
| 1083161038 | Cornerstone Pharmacy Jacksonville LLC | Pharmacy | 315 S James St, Jacksonville, AR 72076-4315 | 2016-09-07 |
| 1326591066 | Sprx2 Inc | Pharmacy | 1201 Monument Rd Ste 100, Jacksonville, FL 32225-6445 | 2016-07-29 |
| 1568822377 | Sprx Inc | Pharmacy | 3740 Saint Johns Bluff Rd S Ste 21, Jacksonville, FL 32224-2650 | 2016-03-07 |
| 1548648363 | Caremax Pharmacy 725 LLC | Pharmacy | 5547 Normandy Blvd, Jacksonville, FL 32205-6246 | 2015-05-13 |
| 1538563580 | Florida A and M University College of Pharmacy | Pharmacy | 2050 Art Museum Dr, Suite 200, Jacksonville, FL 32207-2595 | 2014-10-20 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32224 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.