Provider Demographics
NPI:1548245574
Name:JMRX, PC
Entity Type:Organization
Organization Name:JMRX, PC
Other - Org Name:BOURBON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:REICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MPA
Authorized Official - Phone:574-342-5605
Mailing Address - Street 1:101 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOURBON
Mailing Address - State:IN
Mailing Address - Zip Code:46504-1649
Mailing Address - Country:US
Mailing Address - Phone:574-342-5605
Mailing Address - Fax:574-342-5605
Practice Address - Street 1:101 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOURBON
Practice Address - State:IN
Practice Address - Zip Code:46504-1649
Practice Address - Country:US
Practice Address - Phone:574-342-5605
Practice Address - Fax:574-342-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60005472A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1524239OtherNABP
IN1308210001Medicare ID - Type Unspecified