Provider Demographics
NPI:1356450134
Name:JJM ENTERPRISES INC. , DBA GEM PHARMACY
Entity Type:Organization
Organization Name:JJM ENTERPRISES INC. , DBA GEM PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:COOK
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:303-795-3154
Mailing Address - Street 1:191 E ORCHARD RD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80121-8000
Mailing Address - Country:US
Mailing Address - Phone:303-795-3154
Mailing Address - Fax:303-795-0406
Practice Address - Street 1:191 E ORCHARD RD
Practice Address - Street 2:SUITE #100
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80121-8000
Practice Address - Country:US
Practice Address - Phone:303-795-3154
Practice Address - Fax:303-795-0406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3700000033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03613502Medicaid
CO0609846OtherNABP NUMBER
CO0609846OtherNABP NUMBER