Provider Demographics
NPI:1245239185
Name:MJRX II LLC
Entity Type:Organization
Organization Name:MJRX II LLC
Other - Org Name:BEST BUY DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOCHERHANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-299-4496
Mailing Address - Street 1:1445 WYOMING BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3849
Mailing Address - Country:US
Mailing Address - Phone:505-299-4496
Mailing Address - Fax:505-299-7713
Practice Address - Street 1:1445 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-3849
Practice Address - Country:US
Practice Address - Phone:505-299-4496
Practice Address - Fax:505-299-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPH000040543336C0003X
3336L0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2057193OtherPK
NM63792Medicaid