1043291487 NPI number — J.B.M., INC.

Table of content: (NPI 1043291487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043291487 NPI number — J.B.M., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J.B.M., 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:
Provider Other Organization Name Type Code:
6
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:
1043291487
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1121 BETHLEHEM PIKE
Provider Second Line Business Mailing Address:
SUITE 40
Provider Business Mailing Address City Name:
SPRING HOUSE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19477-1102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-646-1691
Provider Business Mailing Address Fax Number:
215-646-1963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1121 BETHLEHEM PIKE
Provider Second Line Business Practice Location Address:
SUITE 40
Provider Business Practice Location Address City Name:
SPRING HOUSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19477-1102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-646-1691
Provider Business Practice Location Address Fax Number:
215-646-1963
Provider Enumeration Date:
11/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCVAN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRES./PHARMACY MANAGER
Authorized Official Telephone Number:
215-646-1691

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PP414559L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00126794501 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3964106 . This is a "NCPDP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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