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General NPI Number Information
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NPI Number | 1396111829
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Entity Type | Individual
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Provider Name | JENNIFER KIRKUS
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Gender | Female
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 06/03/2017
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Provider Practice Location Address
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Address Line | 11255 CAUSEWAY BLVD
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City | BRANDON
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State | FL
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Zip | 33511-2903
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Country | US
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Telephone | 954-655-1685
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Fax |
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Provider Business Mailing Address
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Address Line | 11782 E DR MARTIN LUTHER KING JR BLVD
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City | SEFFNER
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State | FL
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Zip | 33584
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS53878
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License Number State | FL
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