Healthcare Provider Details

I. General information

NPI: 1710082599
Provider Name (Legal Business Name): JOSEPH DANIEL JUSTINO PHARM D, BCPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 BAY PINES BLVD
BAY PINES FL
33744
US

IV. Provider business mailing address

10000 BAY PINES BLVD
BAY PINES FL
33744-1234
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-6661
  • Fax:
Mailing address:
  • Phone: 727-398-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberPS# 0022113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: