Provider Demographics
NPI:1215578901
Name:JTJ MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:JTJ MEDICAL SUPPLY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SHIERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-317-3033
Mailing Address - Street 1:2692 OAK RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9351
Mailing Address - Country:US
Mailing Address - Phone:800-939-2022
Mailing Address - Fax:855-523-0910
Practice Address - Street 1:1001 MONTICELLO AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2564
Practice Address - Country:US
Practice Address - Phone:800-939-2022
Practice Address - Fax:855-523-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy