Provider Demographics
NPI:1366789190
Name:JANSIK, JOSEPH MICHAEL (RPH)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:JANSIK
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 1:11667 TWIN CREEKS DR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34945-2528
Mailing Address - Country:US
Mailing Address - Phone:772-336-5186
Mailing Address - Fax:
Practice Address - Street 1:788 SE BECKER RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-6621
Practice Address - Country:US
Practice Address - Phone:772-336-5186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0014798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS0014798OtherFLORIDA LICENSE NUMBER