Provider Demographics
NPI:1164458915
Name:MJRRX INC
Entity Type:Organization
Organization Name:MJRRX INC
Other - Org Name:LECHS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-942-8700
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:NICHOLSON
Mailing Address - State:PA
Mailing Address - Zip Code:18446-0600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:56 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:NICHOLSON
Practice Address - State:PA
Practice Address - Zip Code:18446
Practice Address - Country:US
Practice Address - Phone:570-942-8700
Practice Address - Fax:570-942-8702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP481133333600000X
3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012478650002Medicaid
3980415OtherOTHER ID NUMBER-COMMERCIAL NUMBER