Provider Demographics
NPI:1952793606
Name:PANSURIA, JITENDRA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JITENDRA
Middle Name:
Last Name:PANSURIA
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 1:1023 N TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-3545
Mailing Address - Country:US
Mailing Address - Phone:813-645-3871
Mailing Address - Fax:813-645-5433
Practice Address - Street 1:1023 N TAMIAMI TRAIL
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570
Practice Address - Country:US
Practice Address - Phone:813-645-3871
Practice Address - Fax:813-645-5433
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS39383OtherREGISTERED PHARMACIST