Provider Demographics
NPI:1497809842
Name:J AND J PHARMACY INC
Entity Type:Organization
Organization Name:J AND J PHARMACY INC
Other - Org Name:J AND J PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDY
Authorized Official - Suffix:
Authorized Official - Credentials:PHRM
Authorized Official - Phone:817-645-9138
Mailing Address - Street 1:310 N RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-5102
Mailing Address - Country:US
Mailing Address - Phone:817-645-9138
Mailing Address - Fax:817-645-0241
Practice Address - Street 1:310 N RIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-5102
Practice Address - Country:US
Practice Address - Phone:817-645-9138
Practice Address - Fax:817-645-0241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX112853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4515841OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX142815Medicaid
1152390001Medicare NSC