MEDICARE: I & J MEDICAL SUPPLY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1336184704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I & J MEDICAL SUPPLY, INC

Provider Business Mailing Address
First Line	:	10550 NW 77TH CT
Second Line	:	STE 310
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-7084
Country	:	US
Telephone Number	:	305-231-8886
Fax Number	:	305-231-8876

Provider Business Practice Location Address
First Line	:	10550 NW 77TH CT
Second Line	:	STE 310
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-7084
Country	:	US
Telephone Number	:	305-231-8886
Fax Number	:	305-231-8876

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RITA CONCEPCION
Credential	:
Telephone Number	:	305-231-8886

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	06/11/2008

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