Provider Demographics
NPI:1821192899
Name:B-J PHARMACY INC
Entity Type:Organization
Organization Name:B-J PHARMACY INC
Other - Org Name:B AND J PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-847-2288
Mailing Address - Street 1:2111 HUNTER RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-5102
Mailing Address - Country:US
Mailing Address - Phone:512-392-3301
Mailing Address - Fax:512-392-3360
Practice Address - Street 1:2111 HUNTER RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-5102
Practice Address - Country:US
Practice Address - Phone:512-392-3301
Practice Address - Fax:512-392-3360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TX150093336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145108Medicaid
2099558OtherPK
4531249OtherNCPDP PROVIDER IDENTIFICATION NUMBER