Basic Information
| Provider Information | |||||||||
| NPI: | 1619511938 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DRACH | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | COLLET | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 SAN PABLO RD S | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322241036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043803232 | ||||||||
| FaxNumber: | 9043803233 | ||||||||
| Practice Location | |||||||||
| Address1: | 1650 SAN PABLO RD S | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322241036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043803232 | ||||||||
| FaxNumber: | 9043803233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2019 | ||||||||
| LastUpdateDate: | 10/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS41357 | FL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.