Healthcare Provider Details

I. General information

NPI: 1487785580
Provider Name (Legal Business Name): JLM PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1687 ERRINGER RD STE 101
SIMI VALLEY CA
93065-6508
US

IV. Provider business mailing address

1687 ERRINGER RD STE 101
SIMI VALLEY CA
93065-6508
US

V. Phone/Fax

Practice location:
  • Phone: 805-527-9600
  • Fax: 805-527-2095
Mailing address:
  • Phone: 805-527-9600
  • Fax: 805-527-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY51651
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JASON MILES
Title or Position: MILES
Credential: PHARM. D.
Phone: 805-527-9600