Provider Demographics
NPI:1679829501
Name:JUSTMEDS LLC
Entity Type:Organization
Organization Name:JUSTMEDS LLC
Other - Org Name:JUST MEDS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT,PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WINE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-296-5718
Mailing Address - Street 1:51520 NATIONAL RD E
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-8213
Mailing Address - Country:US
Mailing Address - Phone:740-296-5718
Mailing Address - Fax:740-296-5719
Practice Address - Street 1:51520 NATIONAL RD E
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-8213
Practice Address - Country:US
Practice Address - Phone:740-296-5718
Practice Address - Fax:740-296-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRTP022214850033336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074061Medicaid
2136299OtherPK