Basic Information
| Provider Information | |||||||||
| NPI: | 1417411604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAUW | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | RPH, MTM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 SAN PABLO ROAD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9049532000 | ||||||||
| FaxNumber: | 9049532274 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 SAN PABLO ROAD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9049532475 | ||||||||
| FaxNumber: | 9049532274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2019 | ||||||||
| LastUpdateDate: | 01/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS58827 | FL | N | Pharmacy Service Providers | Pharmacist | 1835P2201X | PS58827 | FL | Y |
No ID Information.