=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104785989
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COLIN JANIS
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2026
-----------------------------------------------------
Last Update Date | 01/19/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 BULLARD PKWY
-----------------------------------------------------
City | TEMPLE TERRACE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33617-5510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-432-0651
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 N HOWARD AVE UNIT 210
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33606-1077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS69213
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------