Provider Demographics
NPI:1043487382
Name:J&M PHARMACY AND COMPOUNDING CENTER, LLC
Entity Type:Organization
Organization Name:J&M PHARMACY AND COMPOUNDING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:G
Authorized Official - Last Name:FAUST
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-274-2740
Mailing Address - Street 1:301 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121-1607
Mailing Address - Country:US
Mailing Address - Phone:205-274-2740
Mailing Address - Fax:205-274-7444
Practice Address - Street 1:301 2ND AVE W
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-1607
Practice Address - Country:US
Practice Address - Phone:205-274-2740
Practice Address - Fax:205-274-7444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6343170001Medicare NSC