Healthcare Provider Details

I. General information

NPI: 1619208568
Provider Name (Legal Business Name): JEH-NISSI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 08/09/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 S PARSONS AVE
SEFFNER FL
33584
US

IV. Provider business mailing address

1357 S PARSONS AVE
SEFFNER FL
33584
US

V. Phone/Fax

Practice location:
  • Phone: 813-409-3829
  • Fax: 813-409-3841
Mailing address:
  • Phone: 813-409-3829
  • Fax: 813-409-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH24379
License Number StateFL

VIII. Authorized Official

Name: MR. RONALD JOSEPH BURRIS
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 813-499-1980