Joshua Jeffrey Broadway
Individual provider Active NPI Pharmacist · St Johns, FL
NPI 1104426410 · NPPES record last updated Oct 27, 2020
Key facts
- NPI
- 1104426410
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PS43893 (FL)
- Practice address
- 845 Durbin Pavilion Dr
St Johns, FL 32259-4119 - Phone
- (904) 417-9675
- Fax
- (904) 417-9671
- NPI assigned
- Oct 27, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS43893 | FL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS43893 | FL | Yes |
Addresses
Primary practice location
845 Durbin Pavilion Dr
St Johns, FL 32259-4119
Mailing address
5301 Winrose Falls Dr
Jacksonville, FL 32258-2582
Phone (904) 568-6225
Other providers in St Johns, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.