Healthcare Provider Details

I. General information

NPI: 1306172952
Provider Name (Legal Business Name): J AND J MUSICK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 4TH AVE SE STE 2
CEDAR RAPIDS IA
52403-2445
US

IV. Provider business mailing address

830 4TH AVE SE STE 2
CEDAR RAPIDS IA
52403-2445
US

V. Phone/Fax

Practice location:
  • Phone: 319-362-8976
  • Fax: 319-298-1669
Mailing address:
  • Phone: 319-362-8976
  • Fax: 319-298-1669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number958
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2123126
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: JOEY MUSICK
Title or Position: PRESIDENT
Credential:
Phone: 319-362-8976