Provider Demographics
NPI:1235787037
Name:OXENDINE, BREONNA (RPH)
Entity type:Individual
Prefix:MRS
First Name:BREONNA
Middle Name:
Last Name:OXENDINE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:BREONNA
Other - Middle Name:
Other - Last Name:APPLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2914 LAUREL SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-7270
Mailing Address - Country:US
Mailing Address - Phone:386-336-2475
Mailing Address - Fax:
Practice Address - Street 1:1305 N ORANGE AVE STE 120-123
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-2547
Practice Address - Country:US
Practice Address - Phone:904-284-5677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist