Provider Demographics
NPI:1083966105
Name:JC RESOURCES LLC
Entity Type:Organization
Organization Name:JC RESOURCES LLC
Other - Org Name:GULF SHORE APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:HERWIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-514-4411
Mailing Address - Street 1:689 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-8100
Mailing Address - Country:US
Mailing Address - Phone:239-262-2222
Mailing Address - Fax:239-262-8943
Practice Address - Street 1:689 9TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-8100
Practice Address - Country:US
Practice Address - Phone:239-262-2222
Practice Address - Fax:239-262-8943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH265163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2137494OtherPK
FL007223300Medicaid