Healthcare Provider Details

I. General information

NPI: 1619278934
Provider Name (Legal Business Name): IJEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10173 W COLONIAL DR
OCOEE FL
34761-4209
US

IV. Provider business mailing address

10173 W COLONIAL DR
OCOEE FL
34761-4209
US

V. Phone/Fax

Practice location:
  • Phone: 407-674-7953
  • Fax: 407-674-7955
Mailing address:
  • Phone: 407-674-7953
  • Fax: 407-674-7955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH24979
License Number StateFL

VIII. Authorized Official

Name: MR. BRUNO KEKE
Title or Position: PRESIDENT
Credential:
Phone: 407-674-7953