Provider Demographics
NPI:1952880890
Name:JANGA, SUSHEEL (RPH)
Entity Type:Individual
Prefix:
First Name:SUSHEEL
Middle Name:
Last Name:JANGA
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 1:135 COTTONWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-4778
Mailing Address - Country:US
Mailing Address - Phone:405-503-9927
Mailing Address - Fax:
Practice Address - Street 1:1212 W 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3609
Practice Address - Country:US
Practice Address - Phone:850-640-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist