Provider Demographics
NPI:1801157771
Name:PABON, ISRAEL JR (RPH)
Entity type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:PABON
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6195 SW COUNTY ROAD 242
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-4436
Mailing Address - Country:US
Mailing Address - Phone:561-301-3397
Mailing Address - Fax:
Practice Address - Street 1:6195 SW COUNTY ROAD 242
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024-4436
Practice Address - Country:US
Practice Address - Phone:561-301-3397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0028384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS0028384OtherPHARMACIST LICENSE
307919OtherNABP