Provider Demographics
NPI:1538680111
Name:JAYLEX PHARMACY LLC
Entity Type:Organization
Organization Name:JAYLEX PHARMACY LLC
Other - Org Name:FREEDOMED PHARMACY & COMPOUNDING LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:813-889-9779
Mailing Address - Street 1:5535 MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7332
Mailing Address - Country:US
Mailing Address - Phone:813-889-9779
Mailing Address - Fax:813-889-9724
Practice Address - Street 1:5535 MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-7332
Practice Address - Country:US
Practice Address - Phone:813-889-9779
Practice Address - Fax:813-889-9724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-04
Last Update Date:2017-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy