MEDICARE: BJ'S WHOLESALE CLUB INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1114534245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BJ'S WHOLESALE CLUB INC.

Provider Business Mailing Address
First Line	:	PO BOX 5230
Second Line	:
City	:	WESTBOROUGH
State	:	MA
Zip	:	01581-5230
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 SAINT NICHOLAS DR
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-4767
Country	:	US
Telephone Number	:	301-705-5100
Fax Number	:

Authorized Official
Title or Position	:	LEGAL ASSOCIATE
Name	:	GINA BISCEGLIA
Credential	:
Telephone Number	:	508-688-2358

Provider Enumeration Date	:	09/23/2020
Last Update Date	:	09/23/2020

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