Healthcare Provider Details

I. General information

NPI: 1770915571
Provider Name (Legal Business Name): JMK RX WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35053 ROYALTON RD
GRAFTON OH
44044-9539
US

IV. Provider business mailing address

35053 ROYALTON RD
GRAFTON OH
44044-9539
US

V. Phone/Fax

Practice location:
  • Phone: 440-748-2137
  • Fax: 440-748-3901
Mailing address:
  • Phone: 440-748-2137
  • Fax: 440-748-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number022345800
License Number StateOH

VIII. Authorized Official

Name: SASI KAZA
Title or Position: CEO
Credential:
Phone: 330-990-0960