1982794038 NPI number — L&J PHARMACY, LLC

Table of content: (NPI 1982794038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982794038 NPI number — L&J PHARMACY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
L&J PHARMACY, 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:
CAVES PHARMACY #1189
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:
1982794038
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
916 W EVERGREEN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98660-3035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-213-2236
Provider Business Mailing Address Fax Number:
360-213-2238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 S REDWOOD HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAVE JUNCTION
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97523-9054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-592-4560
Provider Business Practice Location Address Fax Number:
541-592-2500
Provider Enumeration Date:
10/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BLAKESLEE
Authorized Official First Name:
AUSTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL PHARMACY MANAGER
Authorized Official Telephone Number:
360-213-2236

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  RP0001452 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 38-07685 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 168799 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".