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General NPI Number Information
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NPI Number | 1558369140
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Entity Type | Organization
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Legal Business Name | JTJ MEDICAL SUPPLY, INC.
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 2692 OAK RIDGE CT
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City | FORT MYERS
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State | FL
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Zip | 33901-9351
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Country | US
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Telephone | 239-939-9226
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Fax | 239-939-9256
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Provider Business Mailing Address
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Address Line | PO BOX 62134
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City | FORT MYERS
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State | FL
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Zip | 33906-2134
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Country | US
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Telephone | 239-939-9226
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Fax | 239-939-9256
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Authorized Official
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Title or Position | SECRETARY
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Name | LISA MARIE SHIERS
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Credential |
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Telephone | 239-317-3033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH19367
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License Number State | FL
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