Provider Demographics
NPI:1518543859
Name:SITA, COLLINS JAY
Entity Type:Individual
Prefix:
First Name:COLLINS
Middle Name:JAY
Last Name:SITA
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 1:51 ROTONDA CIR
Mailing Address - Street 2:
Mailing Address - City:ROTONDA WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33947-2241
Mailing Address - Country:US
Mailing Address - Phone:941-830-6020
Mailing Address - Fax:
Practice Address - Street 1:1148 E GIBSON ST
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-5011
Practice Address - Country:US
Practice Address - Phone:863-491-5774
Practice Address - Fax:863-491-5350
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist