Provider Demographics
NPI:1891064093
Name:NORRIS, JIM (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:NORRIS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5702 LEE VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-1502
Mailing Address - Country:US
Mailing Address - Phone:407-438-2148
Mailing Address - Fax:407-851-4539
Practice Address - Street 1:5702 LEE VISTA BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1502
Practice Address - Country:US
Practice Address - Phone:407-438-2148
Practice Address - Fax:407-851-4539
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS12009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist