Provider Demographics
NPI:1245833037
Name:BJR
Entity type:Organization
Organization Name:BJR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY JEAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CABILDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:671-971-1655
Mailing Address - Street 1:600 HARMON LOOP RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-6536
Mailing Address - Country:US
Mailing Address - Phone:671-649-6831
Mailing Address - Fax:
Practice Address - Street 1:600 HARMON LOOP RD STE 100
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-6536
Practice Address - Country:US
Practice Address - Phone:671-649-6831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy