1134768831 NPI number — JOYNER RX, LLC

Table of content: (NPI 1114137825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134768831 NPI number — JOYNER RX, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOYNER RX, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134768831
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 236
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SELMER
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38375-0236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
185 W COURT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELMER
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38375-2133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-434-0180
Provider Business Practice Location Address Fax Number:
731-484-0181
Provider Enumeration Date:
12/27/2019

Additional Information

Authorized Official

Authorized Official Last Name:
JOYNER
Authorized Official First Name:
JACK
Authorized Official Middle Name:
TYLER
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
731-610-0104

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Q055972 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com