Provider Demographics
NPI:1407154347
Name:EGLE ENTERPRISES INC
Entity Type:Organization
Organization Name:EGLE ENTERPRISES INC
Other - Org Name:JAXX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHESH
Authorized Official - Middle Name:L
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-739-8101
Mailing Address - Street 1:5890 SW 43RD STREET RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-9554
Mailing Address - Country:US
Mailing Address - Phone:904-739-8101
Mailing Address - Fax:
Practice Address - Street 1:6055 SAINT AUGUSTINE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2104
Practice Address - Country:US
Practice Address - Phone:904-739-8101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH253023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN