Provider Demographics
NPI:1710332135
Name:JCL MANAGEMENT AND CONSULTING LLC
Entity Type:Organization
Organization Name:JCL MANAGEMENT AND CONSULTING LLC
Other - Org Name:TUG VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-316-4011
Mailing Address - Street 1:109 EASTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-7116
Mailing Address - Country:US
Mailing Address - Phone:606-316-4011
Mailing Address - Fax:
Practice Address - Street 1:54 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3506
Practice Address - Country:US
Practice Address - Phone:304-235-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP05525033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVSP0552503OtherWV STATE LISENCE