Provider Demographics
NPI:1477843670
Name:TJD ENTERPRISES, LLC
Entity Type:Organization
Organization Name:TJD ENTERPRISES, LLC
Other - Org Name:MED PLUS PHARMACY OF CARLYLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:DOEHRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-327-3214
Mailing Address - Street 1:18195 EULA MAE PKWY
Mailing Address - Street 2:
Mailing Address - City:CARLYLE
Mailing Address - State:IL
Mailing Address - Zip Code:62231-6406
Mailing Address - Country:US
Mailing Address - Phone:618-594-8385
Mailing Address - Fax:618-594-8591
Practice Address - Street 1:18195 EULA MAE PKWY
Practice Address - Street 2:
Practice Address - City:CARLYLE
Practice Address - State:IL
Practice Address - Zip Code:62231-6406
Practice Address - Country:US
Practice Address - Phone:618-594-8385
Practice Address - Fax:618-594-8591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-10
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.017720333600000X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1485792OtherNCPDP PROVIDER IDENTIFICATION NUMBER