Provider Demographics
NPI:1205060464
Name:JAI BOHLE INC
Entity type:Organization
Organization Name:JAI BOHLE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIPUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-317-3018
Mailing Address - Street 1:2646 NARNIA WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-7231
Mailing Address - Country:US
Mailing Address - Phone:813-388-6875
Mailing Address - Fax:813-388-6871
Practice Address - Street 1:2646 NARNIA WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-7231
Practice Address - Country:US
Practice Address - Phone:813-388-6875
Practice Address - Fax:813-388-6871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-03
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH240463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2120101OtherPK
FL001184200Medicaid