Provider Demographics
NPI:1932244035
Name:RBJ ENTERPRISES, INC.
Entity Type:Organization
Organization Name:RBJ ENTERPRISES, INC.
Other - Org Name:THE MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:814-938-3077
Mailing Address - Street 1:132 W MAHONING ST
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2017
Mailing Address - Country:US
Mailing Address - Phone:814-938-3077
Mailing Address - Fax:814-939-7383
Practice Address - Street 1:132 W MAHONING ST
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2017
Practice Address - Country:US
Practice Address - Phone:814-938-3077
Practice Address - Fax:814-939-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP414376L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012198300001Medicaid
PA3961100OtherNCPDP #
PABT2505266OtherDEA #
PA3961100OtherNCPDP #