Provider Demographics
NPI:1225626716
Name:BYNUM KISSEE, ANTHONY G (PHARM'D)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:G
Last Name:BYNUM KISSEE
Suffix:
Gender:M
Credentials:PHARM'D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4277 STUDIO PARK AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1018
Mailing Address - Country:US
Mailing Address - Phone:267-886-3210
Mailing Address - Fax:
Practice Address - Street 1:7431 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-8712
Practice Address - Country:US
Practice Address - Phone:904-722-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist