Healthcare Provider Details

I. General information

NPI: 1073868386
Provider Name (Legal Business Name): JAG PHARMACY AND HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5335 N MILITARY TRL STE 44
WEST PALM BEACH FL
33407-3033
US

IV. Provider business mailing address

5335 N MILITARY TRL STE 44
WEST PALM BEACH FL
33407-3033
US

V. Phone/Fax

Practice location:
  • Phone: 561-670-2001
  • Fax: 561-828-8454
Mailing address:
  • Phone: 561-670-2001
  • Fax: 561-828-8454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26266
License Number StateFL

VIII. Authorized Official

Name: GANIAT OLUWAMAYOWA
Title or Position: OWNER
Credential:
Phone: 786-877-9297