Provider Demographics
NPI:1851939805
Name:JAY'S ROADHOUSE AND PHARMACY, LLC
Entity Type:Organization
Organization Name:JAY'S ROADHOUSE AND PHARMACY, LLC
Other - Org Name:LYONS LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:970-879-1114
Mailing Address - Street 1:840 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-5005
Mailing Address - Country:US
Mailing Address - Phone:970-879-1115
Mailing Address - Fax:970-879-5643
Practice Address - Street 1:840 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-5005
Practice Address - Country:US
Practice Address - Phone:970-879-1115
Practice Address - Fax:970-879-5643
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAY'S ROADHOUSE AND PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-19
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy