Provider Demographics
NPI:1679038160
Name:MJRLLEW LLC
Entity Type:Organization
Organization Name:MJRLLEW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-317-5133
Mailing Address - Street 1:519 N RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:OH
Mailing Address - Zip Code:43964-1541
Mailing Address - Country:US
Mailing Address - Phone:740-317-5133
Mailing Address - Fax:
Practice Address - Street 1:116 MCLISTER AVE
Practice Address - Street 2:
Practice Address - City:MINGO JUNCTION
Practice Address - State:OH
Practice Address - Zip Code:43938-1259
Practice Address - Country:US
Practice Address - Phone:740-535-8068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy