Provider Demographics
NPI:1124413158
Name:JWA SERVICES INC
Entity Type:Organization
Organization Name:JWA SERVICES INC
Other - Org Name:SIMPLY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:860-865-1303
Mailing Address - Street 1:92 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2421
Mailing Address - Country:US
Mailing Address - Phone:860-865-1303
Mailing Address - Fax:860-437-7323
Practice Address - Street 1:92 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2421
Practice Address - Country:US
Practice Address - Phone:860-865-1303
Practice Address - Fax:860-437-7323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCY.00023123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT7473280001Medicare NSC