Healthcare Provider Details

I. General information

NPI: 1104785989
Provider Name (Legal Business Name): COLIN JANIS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 W BRANDON BLVD
BRANDON FL
33511-4901
US

IV. Provider business mailing address

800 N HOWARD AVE UNIT 210
TAMPA FL
33606-1077
US

V. Phone/Fax

Practice location:
  • Phone: 813-653-4109
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS69213
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: