Healthcare Provider Details

I. General information

NPI: 1346974847
Provider Name (Legal Business Name): JRA HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6925 SE US HIGHWAY 301
HAWTHORNE FL
32640-3966
US

IV. Provider business mailing address

PO BOX 96
HAWTHORNE FL
32640-0096
US

V. Phone/Fax

Practice location:
  • Phone: 352-443-1684
  • Fax: 352-325-4755
Mailing address:
  • Phone: 352-443-1684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN RAMZI AWAD
Title or Position: ADMINISTRATOR
Credential: PHARMD
Phone: 352-443-1684