Provider Demographics
NPI:1023604220
Name:KISHEK, RAMI
Entity type:Individual
Prefix:
First Name:RAMI
Middle Name:
Last Name:KISHEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8235 MAR DEL PLATA ST E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7349
Mailing Address - Country:US
Mailing Address - Phone:904-521-5802
Mailing Address - Fax:
Practice Address - Street 1:8235 MAR DEL PLATA ST E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7349
Practice Address - Country:US
Practice Address - Phone:904-521-5802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-12
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist