Basic Information
| Provider Information | |||||||||
| NPI: | 1235104670 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NAVAL BRANCH HEALTH CLINIC KEY WEST | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | NAVAL HOSPITLA JACKSONVILLE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 DOUGLAS CIRCLE | ||||||||
| Address2: | |||||||||
| City: | KEY WEST | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052934600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1300 DOUGLAS CIR | ||||||||
| Address2: | |||||||||
| City: | KEY WEST | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330404536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052934600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2006 | ||||||||
| LastUpdateDate: | 08/13/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GUARNO | ||||||||
| AuthorizedOfficialFirstName: | LOUIS | ||||||||
| AuthorizedOfficialMiddleName: | VICTOR | ||||||||
| AuthorizedOfficialTitleorPosition: | HEAD, PHARMACY SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 3052934600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | R.PH. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS29644 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Pharmacy Service Providers | Pharmacist |
No ID Information.