Provider Demographics
NPI:1205837531
Name:JMP LTD
Entity Type:Organization
Organization Name:JMP LTD
Other - Org Name:COUCH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PIPPIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:918-743-6154
Mailing Address - Street 1:2602 S HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-4603
Mailing Address - Country:US
Mailing Address - Phone:918-743-6154
Mailing Address - Fax:918-743-6157
Practice Address - Street 1:2602 S HARVARD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-4603
Practice Address - Country:US
Practice Address - Phone:918-743-6154
Practice Address - Fax:918-743-6157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2-2879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3708104OtherNAPB
OK3708104OtherNAPB