Provider Demographics
NPI:1689177552
Name:JP PHARMA LLC
Entity Type:Organization
Organization Name:JP PHARMA LLC
Other - Org Name:KARE PHARMACY & COMPOUNDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-339-9446
Mailing Address - Street 1:411 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4629
Mailing Address - Country:US
Mailing Address - Phone:434-792-8281
Mailing Address - Fax:
Practice Address - Street 1:3534 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4453
Practice Address - Country:US
Practice Address - Phone:540-339-9446
Practice Address - Fax:540-301-3539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-16
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010048273336C0003X
3336C0004X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1689177552Medicaid