Provider Demographics
NPI:1659483592
Name:J & S PROFESSIONAL PHARMCY INC
Entity Type:Organization
Organization Name:J & S PROFESSIONAL PHARMCY INC
Other - Org Name:J AND S PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-937-2416
Mailing Address - Street 1:309 W SAINT LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:WEST FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62896-2099
Mailing Address - Country:US
Mailing Address - Phone:618-937-2416
Mailing Address - Fax:618-932-6433
Practice Address - Street 1:309 W SAINT LOUIS ST
Practice Address - Street 2:
Practice Address - City:WEST FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:62896-2099
Practice Address - Country:US
Practice Address - Phone:618-937-2416
Practice Address - Fax:618-932-6433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL0540093633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2022725OtherPK
IL=========001Medicaid
IL=========001Medicaid