Healthcare Provider Details

I. General information

NPI: 1659319663
Provider Name (Legal Business Name): BJS WHOLESALE CLUB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17250 NW 57TH AVE
HIALEAH FL
33015-5100
US

IV. Provider business mailing address

17250 NW 57TH AVE
HIALEAH FL
33015-5100
US

V. Phone/Fax

Practice location:
  • Phone: 305-557-2440
  • Fax: 305-557-8446
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPH21775
License Number StateFL

VIII. Authorized Official

Name: CHRIS CELLA
Title or Position: ASSISTANT VICE PRESIDENT
Credential: RPH
Phone: 508-651-5621