Provider Demographics
NPI:1518973726
Name:JKW & JIRA INC
Entity Type:Organization
Organization Name:JKW & JIRA INC
Other - Org Name:PHARMACY 1
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:R PH
Authorized Official - Phone:406-245-6717
Mailing Address - Street 1:2900 12TH AVE NORTH
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101
Mailing Address - Country:US
Mailing Address - Phone:406-245-8717
Mailing Address - Fax:406-252-4078
Practice Address - Street 1:2900 12TH AVE NORTH
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101
Practice Address - Country:US
Practice Address - Phone:406-245-8717
Practice Address - Fax:406-252-4078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT212500Medicaid
MT212500Medicaid