Provider Demographics
NPI:1629182696
Name:JBR ENTERPRISES INC
Entity Type:Organization
Organization Name:JBR ENTERPRISES INC
Other - Org Name:ROLAND'S DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-889-5111
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72126-0435
Mailing Address - Country:US
Mailing Address - Phone:501-889-5111
Mailing Address - Fax:501-889-5544
Practice Address - Street 1:112 HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72126-9451
Practice Address - Country:US
Practice Address - Phone:501-889-5111
Practice Address - Fax:501-889-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
ARAR202173336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992810OtherPK
AR140104407Medicaid
AR4315990001Medicare NSC