Organization
JAG PHARMACY AND HEALTH SERVICES
Active
Other names
45TH STREET PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GANIAT OLUWAMAYOWA (OWNER)
(786) 877-9297
Entity
Organization
Contact information
Practice address
5335 N MILITARY TRL STE 44, WEST PALM BEACH, FL 33407-3033
(561) 670-2001
(561) 828-8454
Mailing address
5335 N MILITARY TRL STE 44, WEST PALM BEACH, FL 33407-3033
(561) 670-2001
(561) 828-8454
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH26266
FL
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007284500
—
FL
01
—
2136375
PK
—
Enumeration date
07/24/2012
Last updated
04/20/2016
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