Provider Demographics
NPI:1770595407
Name:CJLM, INC.
Entity type:Organization
Organization Name:CJLM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:270-796-3909
Mailing Address - Street 1:2305 RUSSELLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-3920
Mailing Address - Country:US
Mailing Address - Phone:270-796-3909
Mailing Address - Fax:270-796-4111
Practice Address - Street 1:2305 RUSSELLVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-3920
Practice Address - Country:US
Practice Address - Phone:270-796-3909
Practice Address - Fax:270-796-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY710020835332B00000X
KYPO6802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY710020835Medicaid
KY7100207290Medicaid
KY0612310001Medicare NSC