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General NPI Number Information
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NPI Number | 1972983880
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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 | 06/05/2015
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 1125 N NOVA RD
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4108
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Country | US
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Telephone | 800-939-2022
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Fax | 855-523-0910
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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 | 800-939-2022
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Fax | 855-523-0910
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Authorized Official
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Title or Position | PHARMACY OPERATIONS OFFICER
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Name | LISA SHIERS
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Credential |
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Telephone | 239-939-9226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH29136
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License Number State | FL
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