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General NPI Number Information
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NPI Number | 1003048950
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Entity Type | Organization
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Legal Business Name | JET PHARMACY LLC
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Dates
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Enumeration Date | 08/11/2009
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 2310 W WATERS AVE STE J
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City | TAMPA
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State | FL
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Zip | 33604-2764
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Country | US
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Telephone | 813-933-3458
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Fax | 813-935-5163
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Provider Business Mailing Address
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Address Line | 2310 W WATERS AVE STE J
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City | TAMPA
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State | FL
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Zip | 33604-2764
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Country | US
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Telephone | 813-933-3458
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Fax | 813-935-5163
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Authorized Official
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Title or Position | RPH
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Name | CHARLES SMITH
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Credential |
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Telephone | 813-933-3458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH24178
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License Number State | FL
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