Provider Demographics
NPI:1326556853
Name:JUMEIRAH GLOBAL LLC
Entity Type:Organization
Organization Name:JUMEIRAH GLOBAL LLC
Other - Org Name:JUMEIRAH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MRG
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CASASNOVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-715-0098
Mailing Address - Street 1:604 CRYSTAL PL STE 3
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-1297
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:604 CRYSTAL PL STE 3
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-1297
Practice Address - Country:US
Practice Address - Phone:786-715-0098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP07874333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP07874OtherBOP