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NPI Code Detail

MEDICARE: BEENA JACOB

MEDICARE: BEENA JACOB
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPS36439FL

General Provider Information

NPI Number : 1215101431
Entity Type Code : Individual
Provider Name (Legal Business Name) : BEENA JACOB
Provider Business Mailing Address
First Line : 9206 BARRINGTON OAKS DR
Second Line :
City : DOVER
State : FL
Zip : 33527-3764
Country : US
Telephone Number : 813-662-0846
Fax Number :
Provider Business Practice Location Address
First Line : 13000 BRUCE B DOWNS BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33612-4745
Country : US
Telephone Number : 813-972-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2008
Last Update Date : 04/18/2008

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Directions to “ BEENA JACOB ” Practice Location

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