Provider Demographics
NPI:1831598341
Name:JSW PROSPERITY, LLC
Entity type:Organization
Organization Name:JSW PROSPERITY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUZZETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-471-6891
Mailing Address - Street 1:17310 W GRAND PKWY S STE Z
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2586
Mailing Address - Country:US
Mailing Address - Phone:832-471-6891
Mailing Address - Fax:888-315-3840
Practice Address - Street 1:17310 W GRAND PKWY S STE Z
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2586
Practice Address - Country:US
Practice Address - Phone:832-471-6891
Practice Address - Fax:888-315-3840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX294253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX29425OtherTEXAS BOARD OF PHARMACY