MEDICARE: BJS 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	333600000X	Pharmacy	PHRE008600	GA
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1149637	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1922047372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BJS WHOLESALE CLUB INC

Provider Business Mailing Address
First Line	:	105 LONG DR
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-3766
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 LONG DR
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-3766
Country	:	US
Telephone Number	:	770-928-7943
Fax Number	:	770-516-4253

Authorized Official
Title or Position	:	ASSISTANT VICE PRESIDENT
Name	:	CHRIS CELLA
Credential	:	RPH
Telephone Number	:	508-651-5621

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	09/11/2025

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Directions to “BJS WHOLESALE CLUB INC ” Practice Location

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