Provider Demographics
NPI:1982719910
Name:JSB GROUP LLC
Entity Type:Organization
Organization Name:JSB GROUP LLC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAID MEDICARE BILLING SPEC
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUINN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:314-993-6000
Mailing Address - Street 1:12130 LADUE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2386 N HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-2034
Practice Address - Country:US
Practice Address - Phone:314-921-7700
Practice Address - Fax:314-921-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO194061693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO22038815Medicaid
MO600658108Medicaid
2615752OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MO22038815Medicaid