Healthcare Provider Details

I. General information

NPI: 1942365002
Provider Name (Legal Business Name): JB PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 W NORTHERN AVE
PUEBLO CO
81004-3123
US

IV. Provider business mailing address

915 W NORTHERN AVE
PUEBLO CO
81004-3123
US

V. Phone/Fax

Practice location:
  • Phone: 719-545-1811
  • Fax: 719-545-3878
Mailing address:
  • Phone: 719-545-1811
  • Fax: 719-545-3878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPDO1040000035
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1040000035
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPDO1040000035
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEANETTE MARIE BURNS
Title or Position: MANAGER-OWNER
Credential:
Phone: 719-545-1811