Provider Demographics
NPI:1073983144
Name:BJRX PHARMACY LTC INC
Entity Type:Organization
Organization Name:BJRX PHARMACY LTC INC
Other - Org Name:BJRX PHARMACY LTC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRATAP
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-474-3888
Mailing Address - Street 1:1801 E MARCH LN
Mailing Address - Street 2:SUITE:B270
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-6629
Mailing Address - Country:US
Mailing Address - Phone:209-474-3888
Mailing Address - Fax:209-474-3328
Practice Address - Street 1:1801 E MARCH LN # 270
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-6629
Practice Address - Country:US
Practice Address - Phone:209-451-3171
Practice Address - Fax:209-451-3635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 536173336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154419OtherPK
CAPHY 53617OtherPHARMACY LICENSE
FB5589758OtherDEA LICENSE