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General NPI Number Information
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NPI Number | 1295042133
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Entity Type | Organization
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Legal Business Name | JYA, LLC
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Dates
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Enumeration Date | 09/13/2010
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 2200 SOUTH BLVD W
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City | DAVENPORT
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State | FL
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Zip | 33837-7002
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Country | US
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Telephone | 863-421-9200
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Fax | 863-421-9220
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Provider Business Mailing Address
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Address Line | 2200 SOUTH BLVD W
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City | DAVENPORT
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State | FL
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Zip | 33837-7002
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Country | US
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Telephone | 863-421-9200
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Fax | 863-421-9220
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Authorized Official
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Title or Position | PHARMACY MANAGER/OWNER
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Name | DR. YAHAYA FIDELIS ABUH
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Credential | PHD, RPH
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Telephone | 863-330-0681
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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 | PH24823
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License Number State | FL
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