Provider Demographics
NPI:1255679080
Name:JRX PHARMACY LLC
Entity Type:Organization
Organization Name:JRX PHARMACY LLC
Other - Org Name:JRX PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SMRUTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:JANNU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:813-874-2900
Mailing Address - Street 1:4024 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5628
Mailing Address - Country:US
Mailing Address - Phone:813-874-2900
Mailing Address - Fax:813-874-2909
Practice Address - Street 1:4024 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5628
Practice Address - Country:US
Practice Address - Phone:813-874-2900
Practice Address - Fax:813-874-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
FLPH263973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020234400Medicaid
2137688OtherPK