Provider Demographics
NPI:1053409284
Name:J.L.FOLSOM ENTERPRISES INC
Entity type:Organization
Organization Name:J.L.FOLSOM ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:FOLSOM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:407-539-1110
Mailing Address - Street 1:433 S ORLANDO AVE
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5646
Mailing Address - Country:US
Mailing Address - Phone:407-539-1110
Mailing Address - Fax:407-539-0749
Practice Address - Street 1:433 S ORLANDO AVE
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5646
Practice Address - Country:US
Practice Address - Phone:407-539-1110
Practice Address - Fax:407-539-0749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10569173000000X
FL14494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0813550001Medicare NSC