Provider Demographics
NPI:1598776007
Name:J & B SCHUCKMAN INC
Entity Type:Organization
Organization Name:J & B SCHUCKMAN INC
Other - Org Name:MEDICINE PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JADE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-275-3383
Mailing Address - Street 1:2412 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-3010
Mailing Address - Country:US
Mailing Address - Phone:812-275-3383
Mailing Address - Fax:812-275-0384
Practice Address - Street 1:2412 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3010
Practice Address - Country:US
Practice Address - Phone:812-275-3383
Practice Address - Fax:812-275-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IN60005748A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1521699OtherNCPDP PROVIDER IDENTIFICATION NUMBER
IN200423510AMedicaid