Provider Demographics
NPI:1497825574
Name:JT BAD INC
Entity Type:Organization
Organization Name:JT BAD INC
Other - Org Name:LEHIGHTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHCST
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-377-9070
Mailing Address - Street 1:281 N 12TH ST
Mailing Address - Street 2:STE C
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-1101
Mailing Address - Country:US
Mailing Address - Phone:610-377-9070
Mailing Address - Fax:610-377-9072
Practice Address - Street 1:281 N 12TH ST
Practice Address - Street 2:STE C
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1101
Practice Address - Country:US
Practice Address - Phone:610-377-9070
Practice Address - Fax:610-377-9072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4811903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001929423001Medicaid
3981227OtherNCPDP PROVIDER IDENTIFICATION NUMBER
PA001929423001Medicaid