Provider Demographics
NPI:1720093321
Name:MJRRX INC
Entity Type:Organization
Organization Name:MJRRX INC
Other - Org Name:LECHS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COOWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:STAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-836-6333
Mailing Address - Street 1:1 KIM AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-9101
Mailing Address - Country:US
Mailing Address - Phone:570-836-6333
Mailing Address - Fax:570-836-5214
Practice Address - Street 1:1 KIM AVE STE 1
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-9101
Practice Address - Country:US
Practice Address - Phone:570-836-6333
Practice Address - Fax:570-836-5214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP415149L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012478650001Medicaid
2083194OtherPK
PA1012478650001Medicaid