Provider Demographics
NPI:1891754750
Name:MJRX LLC
Entity Type:Organization
Organization Name:MJRX LLC
Other - Org Name:RX INNOVATIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCHERHANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-881-4601
Mailing Address - Street 1:7209 JEFFERSON ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4307
Mailing Address - Country:US
Mailing Address - Phone:505-881-4601
Mailing Address - Fax:505-881-4647
Practice Address - Street 1:7209 JEFFERSON ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4307
Practice Address - Country:US
Practice Address - Phone:505-881-4601
Practice Address - Fax:505-881-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 332BP3500X, 333600000X, 3336M0003X
NMPH000037333336L0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2147882OtherPK
NM25307541Medicaid