Healthcare Provider Details

I. General information

NPI: 1043602618
Provider Name (Legal Business Name): JONELEEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 W DR MARTIN LUTHER KING JR BLVD STE D
TAMPA FL
33607-6529
US

IV. Provider business mailing address

1931 W DR MARTIN LUTHER KING JR BLVD STE D
TAMPA FL
33607-6529
US

V. Phone/Fax

Practice location:
  • Phone: 813-803-7303
  • Fax: 813-803-7305
Mailing address:
  • Phone: 813-803-7303
  • Fax: 813-803-7305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH28524
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DANIEL MUSCA
Title or Position: MANAGER
Credential:
Phone: 813-803-7303