Healthcare Provider Details

I. General information

NPI: 1003976036
Provider Name (Legal Business Name): BJS WHOLESALE CLUB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 BEN C PRATT SIX MILE CYPRESS PKWY
FORT MYERS FL
33912
US

IV. Provider business mailing address

9300 BEN C PRATT SIX MILE CYPRESS PKWY
FORT MYERS FL
33912
US

V. Phone/Fax

Practice location:
  • Phone: 239-896-1085
  • Fax: 239-896-1086
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH22406
License Number StateFL

VIII. Authorized Official

Name: CHRIS CELLA
Title or Position: VICE PRES OF PHCY OPER
Credential: RPH
Phone: 508-651-5621