Provider Demographics
NPI:1467524066
Name:CA & JL ENTERPRISES INC
Entity Type:Organization
Organization Name:CA & JL ENTERPRISES INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:501-843-5846
Mailing Address - Street 1:521 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-2420
Mailing Address - Country:US
Mailing Address - Phone:501-843-5846
Mailing Address - Fax:501-843-2758
Practice Address - Street 1:521 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2420
Practice Address - Country:US
Practice Address - Phone:501-843-5846
Practice Address - Fax:501-843-2758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0418548333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125298407Medicaid
AR0418548OtherNCPDP
AR154176716Medicaid
AR125298407Medicaid
AR1305150001Medicare NSC
ARP00711071Medicare PIN