Provider Demographics
NPI:1043291487
Name:J.B.M., INC.
Entity Type:Organization
Organization Name:J.B.M., INC.
Other - Org Name:VILLAGE PHARMACY AT SPRINGHOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES./PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCVAN
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-646-1691
Mailing Address - Street 1:1121 BETHLEHEM PIKE
Mailing Address - Street 2:SUITE 40
Mailing Address - City:SPRING HOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:19477-1102
Mailing Address - Country:US
Mailing Address - Phone:215-646-1691
Mailing Address - Fax:215-646-1963
Practice Address - Street 1:1121 BETHLEHEM PIKE
Practice Address - Street 2:SUITE 40
Practice Address - City:SPRING HOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477-1102
Practice Address - Country:US
Practice Address - Phone:215-646-1691
Practice Address - Fax:215-646-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP414559L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00126794501Medicaid
PA3964106OtherNCPDP #