Provider Demographics
NPI:1346305778
Name:JUAN AND JOHN DRUGS
Entity Type:Organization
Organization Name:JUAN AND JOHN DRUGS
Other - Org Name:K AND M DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAITHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:863-983-7277
Mailing Address - Street 1:340 E SUGARLAND HWY
Mailing Address - Street 2:STE H
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-3124
Mailing Address - Country:US
Mailing Address - Phone:863-983-7277
Mailing Address - Fax:863-983-7229
Practice Address - Street 1:340 E SUGARLAND HWY
Practice Address - Street 2:STE A
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3124
Practice Address - Country:US
Practice Address - Phone:863-983-7277
Practice Address - Fax:863-983-7229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
FLPH139073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2009844OtherPK
FL103463400Medicaid
FL103463400Medicaid