Provider Demographics
NPI:1215539853
Name:SILAS, JOS
Entity Type:Individual
Prefix:
First Name:JOS
Middle Name:
Last Name:SILAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2762 VERANDAH VUE WAY
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-6392
Mailing Address - Country:US
Mailing Address - Phone:863-370-6645
Mailing Address - Fax:
Practice Address - Street 1:355 CYPRESS GDN BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4452
Practice Address - Country:US
Practice Address - Phone:863-299-5131
Practice Address - Fax:863-299-0548
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist