Provider Demographics
NPI:1730918418
Name:AULT, JOSEPH M
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:AULT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14085 E PARSLEY DR
Mailing Address - Street 2:
Mailing Address - City:MADEIRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-2301
Mailing Address - Country:US
Mailing Address - Phone:908-342-5126
Mailing Address - Fax:
Practice Address - Street 1:14085 E PARSLEY DR
Practice Address - Street 2:
Practice Address - City:MADEIRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33708-2301
Practice Address - Country:US
Practice Address - Phone:908-342-5126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0022343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist