Provider Demographics
NPI:1629148853
Name:J & B MEDICAL SUPPLY CO INC
Entity Type:Organization
Organization Name:J & B MEDICAL SUPPLY CO INC
Other - Org Name:J & B MEDICAL SUPPLY CO INC DIS
Other - Org Type:Other Name
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-737-0045
Mailing Address - Street 1:50496 W PONTIAC TRAIL
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393
Mailing Address - Country:US
Mailing Address - Phone:800-737-0045
Mailing Address - Fax:248-960-8082
Practice Address - Street 1:50496 W PONTIAC TRAIL
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393
Practice Address - Country:US
Practice Address - Phone:800-737-0045
Practice Address - Fax:248-960-8082
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J & B MEDICAL SUPPLY CO INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-08
Last Update Date:2007-12-04
Deactivation Date:2007-05-10
Deactivation Code:
Reactivation Date:2007-12-04
Provider Licenses
StateLicense IDTaxonomies
MIBME0145457332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5306001467OtherBOARD OF PHARMACY MFR&WLH
MI4596947Medicaid
MI5306001467OtherBOARD OF PHARMACY MFR&WLH