Provider Demographics
NPI:1235950346
Name:JW2 LLC
Entity type:Organization
Organization Name:JW2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:JACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:435-900-1008
Mailing Address - Street 1:922 E BRIGHAM RD BLDG 4D
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8751
Mailing Address - Country:US
Mailing Address - Phone:435-900-1008
Mailing Address - Fax:435-900-1009
Practice Address - Street 1:922 E BRIGHAM RD BLDG 4D
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8751
Practice Address - Country:US
Practice Address - Phone:435-900-1008
Practice Address - Fax:435-900-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy