Provider Demographics
NPI:1376537902
Name:M D J INC
Entity Type:Organization
Organization Name:M D J INC
Other - Org Name:BEYER'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BEYER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:812-926-2884
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IN
Mailing Address - Zip Code:47001-0209
Mailing Address - Country:US
Mailing Address - Phone:812-926-0552
Mailing Address - Fax:812-926-0697
Practice Address - Street 1:312 3RD ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IN
Practice Address - Zip Code:47001-1310
Practice Address - Country:US
Practice Address - Phone:812-926-0552
Practice Address - Fax:812-926-0697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100294810AMedicaid