MEDICARE: JRVS 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	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PP413456L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2146370	OTHER		PK

General Provider Information

NPI Number	:	1700882057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JRVS LLC

Provider Business Mailing Address
First Line	:	1639 HAINES RD
Second Line	:
City	:	LEVITTOWN
State	:	PA
Zip	:	19055-1803
Country	:	US
Telephone Number	:	215-547-0250
Fax Number	:	215-547-0202

Provider Business Practice Location Address
First Line	:	1639 HAINES RD
Second Line	:
City	:	LEVITTOWN
State	:	PA
Zip	:	19055-1803
Country	:	US
Telephone Number	:	215-547-0250
Fax Number	:	215-547-0202

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	JIGNESH PATEL
Credential	:	MS RPH
Telephone Number	:	215-547-0250

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	12/07/2022

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