Provider Demographics
NPI:1629109780
Name:JOINT VENTURE PHARMACY, INC.
Entity Type:Organization
Organization Name:JOINT VENTURE PHARMACY, INC.
Other - Org Name:HOLZER FAMILY PHARMACY JACKSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:JAN
Authorized Official - Last Name:GAISER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-395-8870
Mailing Address - Street 1:280 PATTONSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-9452
Mailing Address - Country:US
Mailing Address - Phone:740-395-8870
Mailing Address - Fax:740-395-8897
Practice Address - Street 1:280 PATTONSVILLE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9452
Practice Address - Country:US
Practice Address - Phone:740-395-8870
Practice Address - Fax:740-395-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2163144Medicaid
5003140001Medicare ID - Type Unspecified