Provider Demographics
NPI:1033142468
Name:CJ MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:CJ MEDICAL SUPPLIES INC
Other - Org Name:CJ PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:E
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-252-1755
Mailing Address - Street 1:13350 NW 42 AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054
Mailing Address - Country:US
Mailing Address - Phone:305-688-1335
Mailing Address - Fax:305-688-1779
Practice Address - Street 1:13350 NW 42 AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054
Practice Address - Country:US
Practice Address - Phone:305-688-1335
Practice Address - Fax:305-688-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312366332B00000X
FL3203829332BX2000X
FLPH219633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5324970001Medicare NSC
FL5324970001Medicare PIN