MEDICARE: JIMMY STEPHANO DUMORNAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS39154	FL

General Provider Information

NPI Number	:	1083764898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMY STEPHANO DUMORNAY

Provider Business Mailing Address
First Line	:	1117 ANDREW AVILES CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-5007
Country	:	US
Telephone Number	:	813-476-7724
Fax Number	:

Provider Business Practice Location Address
First Line	:	1117 ANDREW AVILES CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-5007
Country	:	US
Telephone Number	:	781-775-7182
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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