Provider Demographics
NPI:1467490177
Name:EJ AND JJ INC
Entity Type:Organization
Organization Name:EJ AND JJ INC
Other - Org Name:THE MEDICINE SHOPPE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JISUK
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:201-944-1002
Mailing Address - Street 1:2468 LEMOINE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6206
Mailing Address - Country:US
Mailing Address - Phone:201-944-1002
Mailing Address - Fax:201-944-6336
Practice Address - Street 1:2468 LEMOINE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6206
Practice Address - Country:US
Practice Address - Phone:201-944-1002
Practice Address - Fax:201-944-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS005340003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6996906Medicaid
NJ6996914Medicaid
NJ45PD00000700OtherORTHOTICS & PROSTHETICS( PEDORTHIST)
NJ5716530001Medicare NSC
NJ5716530001Medicare NSC
NJ45PD00000700OtherORTHOTICS & PROSTHETICS( PEDORTHIST)