1427073790 NPI number — J & L PHARMACY, INC

Table of content: (NPI 1427073790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427073790 NPI number — J & L PHARMACY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J & L PHARMACY, INC
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:
MEDICAL CENTER PHARMACY, MEDICAL CENTER PHARMACY VITAL CARE
Provider Other Organization Name Type Code:
3
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:
1427073790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5047
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39302-5047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-447-4095
Provider Business Mailing Address Fax Number:
601-482-7490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W 26TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77803-3232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-822-3575
Provider Business Practice Location Address Fax Number:
979-823-7278
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MUTZ
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
979-822-3575

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  12500 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , with the licence number: 12500 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X , with the licence number: 12500 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 12500 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 12500 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 12500 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 12500 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 12500 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336M0002X , with the licence number: 12500 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 12500 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 013833101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 750655 . This is a "BCBS HIT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1209983-04 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 519933 . This is a "BCBS DME" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 104686100 . This is a "FIRSTCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 722475922-0001 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1209983-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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