MEDICARE: JIM NORRIS PHARMACIST

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
1	183500000X	Pharmacist	PS12009	FL

General Provider Information

NPI Number	:	1891064093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIM NORRIS PHARMACIST

Provider Business Mailing Address
First Line	:	5702 LEE VISTA BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-1502
Country	:	US
Telephone Number	:	407-438-2148
Fax Number	:	407-851-4539

Provider Business Practice Location Address
First Line	:	5702 LEE VISTA BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-1502
Country	:	US
Telephone Number	:	407-438-2148
Fax Number	:	407-851-4539

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2011
Last Update Date	:	12/19/2011

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