Provider Demographics
NPI:1740528371
Name:MA, JEFFREY (PHARM D)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:MA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 THONOTOSASSA RD
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-1464
Mailing Address - Country:US
Mailing Address - Phone:813-719-6933
Mailing Address - Fax:813-754-8195
Practice Address - Street 1:2515 THONOTOSASSA RD
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-1464
Practice Address - Country:US
Practice Address - Phone:813-719-6933
Practice Address - Fax:813-754-8195
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist