Provider Demographics
NPI:1164013603
Name:J & M PHARMACY LLC
Entity Type:Organization
Organization Name:J & M PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:606-910-0555
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:BULAN
Mailing Address - State:KY
Mailing Address - Zip Code:41722
Mailing Address - Country:US
Mailing Address - Phone:606-910-0555
Mailing Address - Fax:606-910-0124
Practice Address - Street 1:1587 COMBS RD., SUITE 2
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-8524
Practice Address - Country:US
Practice Address - Phone:606-910-0555
Practice Address - Fax:606-910-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP08165OtherPERMIT #