Provider Demographics
NPI:1790836740
Name:JPIE INC.
Entity Type:Organization
Organization Name:JPIE INC.
Other - Org Name:DIXON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PIETRYGA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:815-288-3384
Mailing Address - Street 1:742 N GALENA AVE
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-1510
Mailing Address - Country:US
Mailing Address - Phone:815-288-3384
Mailing Address - Fax:815-288-7813
Practice Address - Street 1:742 N GALENA AVE
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-1510
Practice Address - Country:US
Practice Address - Phone:815-288-3384
Practice Address - Fax:815-288-7813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4331985733001Medicaid