MEDICARE: BRIAN ENNIS

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	30392	NC

General Provider Information

NPI Number	:	1992200588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN ENNIS

Provider Business Mailing Address
First Line	:	401 E JACKSON ST STE 3300
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-5228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 E JACKSON ST STE 3300
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-5228
Country	:	US
Telephone Number	:	866-277-3679
Fax Number	:

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

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	08/22/2022

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Directions to “ BRIAN ENNIS ” Practice Location

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