Healthcare Provider Details

I. General information

NPI: 1972108991
Provider Name (Legal Business Name): JAMES CILLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 34TH ST N
SAINT PETERSBURG FL
33713-3612
US

IV. Provider business mailing address

502 S FREMONT AVE APT 1039
TAMPA FL
33606-4310
US

V. Phone/Fax

Practice location:
  • Phone: 727-328-7644
  • Fax:
Mailing address:
  • Phone: 772-342-3771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS53407
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: