Provider Demographics
NPI:1619208568
Name:JEH-NISSI INC
Entity Type:Organization
Organization Name:JEH-NISSI INC
Other - Org Name:SALLYKAY PHARMACY #001
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLUKAYODE
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNDIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-503-4858
Mailing Address - Street 1:735 MARTIN LUTHER KING BLVD W
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-4533
Mailing Address - Country:US
Mailing Address - Phone:813-409-3829
Mailing Address - Fax:
Practice Address - Street 1:735 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-4533
Practice Address - Country:US
Practice Address - Phone:813-409-3829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH243793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1052593OtherNCPDP PROVIDER IDENTIFICATION NUMBER