Provider Demographics
NPI: | 1629210943 |
---|---|
Name: | HT THREE LLC |
Entity Type: | Organization |
Organization Name: | HT THREE LLC |
Other - Org Name: | J&L PHARMACY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | JOHN |
Authorized Official - Middle Name: | S |
Authorized Official - Last Name: | GOOVER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RPH |
Authorized Official - Phone: | 800-950-9120 |
Mailing Address - Street 1: | 8300 E MAPLEWOOD AVE |
Mailing Address - Street 2: | SUITE 100 |
Mailing Address - City: | GREENWOOD VILLAGE |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80111-4804 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-950-9120 |
Mailing Address - Fax: | 303-221-7775 |
Practice Address - Street 1: | 4606 46TH AVE |
Practice Address - Street 2: | |
Practice Address - City: | ROCK ISLAND |
Practice Address - State: | IL |
Practice Address - Zip Code: | 61201-7143 |
Practice Address - Country: | US |
Practice Address - Phone: | 309-786-2124 |
Practice Address - Fax: | 888-269-1077 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-04-01 |
Last Update Date: | 2009-04-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 054-16641 | 3336C0003X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |