Provider Demographics
NPI:1295042133
Name:JYA, LLC
Entity Type:Organization
Organization Name:JYA, LLC
Other - Org Name:WEBB'S SQUARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YAHAYA
Authorized Official - Middle Name:FIDELIS
Authorized Official - Last Name:ABUH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RPH
Authorized Official - Phone:863-224-7234
Mailing Address - Street 1:141 WEBB DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-3951
Mailing Address - Country:US
Mailing Address - Phone:863-421-9200
Mailing Address - Fax:863-421-9220
Practice Address - Street 1:141 WEBB DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3951
Practice Address - Country:US
Practice Address - Phone:863-421-9200
Practice Address - Fax:863-421-9220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH248233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy