MEDICARE: MR. JOSEPH MICHAEL JANSIK RPH

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	PS0014798	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS0014798	OTHER	FL	FLORIDA LICENSE NUMBER

General Provider Information

NPI Number	:	1366789190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH MICHAEL JANSIK RPH

Provider Business Mailing Address
First Line	:	11667 TWIN CREEKS DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34945-2528
Country	:	US
Telephone Number	:	772-336-5186
Fax Number	:

Provider Business Practice Location Address
First Line	:	788 SE BECKER RD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34984-6621
Country	:	US
Telephone Number	:	772-336-5186
Fax Number	:

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

Provider Enumeration Date	:	01/14/2013
Last Update Date	:	01/14/2013

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