Provider Demographics
NPI:1184634131
Name:PBJ PARTNERS LLC
Entity Type:Organization
Organization Name:PBJ PARTNERS LLC
Other - Org Name:SPECIALTY CARE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:R
Authorized Official - Last Name:MONTANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-506-1300
Mailing Address - Street 1:4621 WICHERS DR
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3020
Mailing Address - Country:US
Mailing Address - Phone:504-340-5221
Mailing Address - Fax:504-340-5228
Practice Address - Street 1:4621 WICHERS DR
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3020
Practice Address - Country:US
Practice Address - Phone:504-340-5221
Practice Address - Fax:504-340-5228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
LAPHY.004002-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1274810Medicaid
2032959OtherPK
1086040001Medicare NSC
1924996OtherOTHER ID NUMBER