Organization
JEH-NISSI INC
Active
Other names
Prestige Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD JOSEPH BURRIS (OWNER/PRESIDENT)
(813) 499-1980
Entity
Organization
Contact information
Practice address
1357 S PARSONS AVE, SEFFNER, FL 33584
(813) 409-3829
(813) 409-3841
Mailing address
1357 S PARSONS AVE, SEFFNER, FL 33584
(813) 409-3829
(813) 409-3841
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH24379
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002065500
—
FL
01
—
1052593
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/15/2010
Last updated
08/09/2024
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