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General NPI Number Information
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NPI Number | 1437372588
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Entity Type | Individual
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Provider Name | JACK C TESTASECCA RPH
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Gender | Male
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1615 SUN CITY CENTER PLZ
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City | SUN CITY CENTER
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State | FL
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Zip | 33573-5385
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Country | US
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Telephone | 813-634-1729
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Fax | 813-642-0421
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Provider Business Mailing Address
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Address Line | 2205 MISTY RIDGE LN
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City | VALRICO
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State | FL
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Zip | 33594-5537
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Country | US
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Telephone | 813-654-5141
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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 | 11942
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License Number State | FL
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