MEDICARE: AISSA JONES PHARMD

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	PS48530	FL

General Provider Information

NPI Number	:	1588207278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AISSA JONES PHARMD

Provider Business Mailing Address
First Line	:	13741 SACHS AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7511
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5216 RED BUG LAKE RD
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-4912
Country	:	US
Telephone Number	:	407-699-7055
Fax Number	:	407-699-7060

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

Provider Enumeration Date	:	10/24/2019
Last Update Date	:	10/24/2019

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