Provider Demographics
NPI:1497381511
Name:JTJ MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:JTJ MEDICAL SUPPLY, INC.
Other - Org Name:MAIL-MEDS CLINICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:THEOBALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-939-9226
Mailing Address - Street 1:PO BOX 62134
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33906-2134
Mailing Address - Country:US
Mailing Address - Phone:800-939-9226
Mailing Address - Fax:855-523-0910
Practice Address - Street 1:2331 W ROYAL PALM RD STE E
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4940
Practice Address - Country:US
Practice Address - Phone:800-939-9226
Practice Address - Fax:855-523-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-20
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy