Provider Demographics
NPI:1205959152
Name:GISEL, JEFF R (RPH)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:R
Last Name:GISEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 HAMPSTEAD TER
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5141
Mailing Address - Country:US
Mailing Address - Phone:407-366-3821
Mailing Address - Fax:
Practice Address - Street 1:1432 HAMPSTEAD TER
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5141
Practice Address - Country:US
Practice Address - Phone:407-366-3821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist