MEDICARE: J-M WARD ENTERPRISES 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
2	3336C0004X	Compounding Pharmacy
3	333600000X	Pharmacy	PH24311	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1050171	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1952637449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J-M WARD ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	9048 BONITA BEACH RD SE
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-4237
Country	:	US
Telephone Number	:	239-221-7233
Fax Number	:	239-221-7282

Provider Business Practice Location Address
First Line	:	9048 BONITA BEACH RD SE
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-4237
Country	:	US
Telephone Number	:	239-221-7233
Fax Number	:	239-221-7282

Authorized Official
Title or Position	:	OWNER/ PHARMACY TECH
Name	:	JOHN BREWER
Credential	:
Telephone Number	:	239-221-7233

Provider Enumeration Date	:	10/19/2009
Last Update Date	:	11/16/2017

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Directions to “J-M WARD ENTERPRISES LLC ” Practice Location

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