MEDICARE: JR SCRIPTS PHARMACY NO 1 LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1194350256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JR SCRIPTS PHARMACY NO 1 LLC

Provider Business Mailing Address
First Line	:	1238 S 3RD ST STE C
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47802-0018
Country	:	US
Telephone Number	:	812-234-8305
Fax Number	:	812-234-0225

Provider Business Practice Location Address
First Line	:	2902 POPLAR ST
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47803-2661
Country	:	US
Telephone Number	:	812-478-1006
Fax Number	:	812-478-9296

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TERRY J WARREN
Credential	:
Telephone Number	:	765-828-1003

Provider Enumeration Date	:	03/10/2020
Last Update Date	:	01/22/2026

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