Provider Demographics
NPI:1508385477
Name:JKW & JIRA INC.
Entity Type:Organization
Organization Name:JKW & JIRA INC.
Other - Org Name:PHARMACY 1 AT THE MHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JARROD
Authorized Official - Last Name:WILLEMS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:406-601-3392
Mailing Address - Street 1:2900 12TH AVE N STE 110A
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7506
Mailing Address - Country:US
Mailing Address - Phone:406-245-6717
Mailing Address - Fax:406-252-4078
Practice Address - Street 1:1245 N 29TH ST STE 100
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101
Practice Address - Country:US
Practice Address - Phone:406-601-3392
Practice Address - Fax:877-743-0496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHR-LIC-473623336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTPHA-PHR-LIC-47362OtherSTATE OF MONTANA PHARMACY LICENSE