Provider Demographics
NPI:1679116446
Name:TJAK GROUP LLC
Entity Type:Organization
Organization Name:TJAK GROUP LLC
Other - Org Name:BELL DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:PARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-337-5050
Mailing Address - Street 1:114 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-1647
Mailing Address - Country:US
Mailing Address - Phone:606-337-5050
Mailing Address - Fax:
Practice Address - Street 1:114 N PINE ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-1647
Practice Address - Country:US
Practice Address - Phone:606-337-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy