Provider Demographics
NPI:1982746400
Name:JP COMPANIES OF VIRGINIA INC
Entity Type:Organization
Organization Name:JP COMPANIES OF VIRGINIA INC
Other - Org Name:FAMILY DRUG MART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PROSNICK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:218-749-8943
Mailing Address - Street 1:1400 S 13TH AVE
Mailing Address - Street 2:PO BOX 76
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-3364
Mailing Address - Country:US
Mailing Address - Phone:218-749-8943
Mailing Address - Fax:218-749-8954
Practice Address - Street 1:1400 S 13TH AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-3364
Practice Address - Country:US
Practice Address - Phone:218-749-8943
Practice Address - Fax:218-749-8954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN260477-63336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0500660001Medicare NSC