Provider Demographics
NPI:1346060183
Name:JTJ MEDICAL SUPPLY, INC
Entity type:Organization
Organization Name:JTJ MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLEY-CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-939-2022
Mailing Address - Street 1:PO BOX 62134
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33906-2134
Mailing Address - Country:US
Mailing Address - Phone:800-939-2022
Mailing Address - Fax:855-523-0910
Practice Address - Street 1:1820 E SAHARA AVE STE 201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3721
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:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy