Organization
ST JUDES PHARMACY INC
Active
Other names
St Judes Pharmacy Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
JORGE OTANO (OWNER/PRESIDENT)
(239) 673-7777
Entity
Organization
Contact information
Practice address
1202 NE PINE ISLAND RD, STE IV, CAPE CORAL, FL 33909-2197
(239) 673-7777
(239) 673-7778
Mailing address
1202 NE PINE ISLAND RD, UNIT IV, CAPE CORAL, FL 33909-2197
(239) 673-7777
(239) 673-7778
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH24077
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001426500
—
FL
01
—
1045841
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/02/2009
Last updated
08/12/2010
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