MEDICARE: JSW PROSPERITY, LLC

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	3336C0003X	Community/Retail Pharmacy	29425	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	29425	OTHER	TX	TEXAS BOARD OF PHARMACY

General Provider Information

NPI Number	:	1831598341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JSW PROSPERITY, LLC

Provider Business Mailing Address
First Line	:	17310 W GRAND PKWY S STE Z
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-2586
Country	:	US
Telephone Number	:	832-471-6891
Fax Number	:	888-315-3840

Provider Business Practice Location Address
First Line	:	17310 W GRAND PKWY S STE Z
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-2586
Country	:	US
Telephone Number	:	832-471-6891
Fax Number	:	888-315-3840

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. NICHOLE BUZZETTA
Credential	:
Telephone Number	:	832-471-6891

Provider Enumeration Date	:	08/20/2014
Last Update Date	:	07/21/2022

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Directions to “JSW PROSPERITY, LLC ” Practice Location

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