Healthcare Provider Details

I. General information

NPI: 1952637449
Provider Name (Legal Business Name): J-M WARD ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9048 BONITA BEACH RD SE
BONITA SPRINGS FL
34135-4237
US

IV. Provider business mailing address

9048 BONITA BEACH RD SE
BONITA SPRINGS FL
34135-4237
US

V. Phone/Fax

Practice location:
  • Phone: 239-221-7233
  • Fax: 239-221-7282
Mailing address:
  • Phone: 239-221-7233
  • Fax: 239-221-7282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH24311
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN BREWER
Title or Position: OWNER/ PHARMACY TECH
Credential:
Phone: 239-221-7233