Healthcare Provider Details

I. General information

NPI: 1548245574
Provider Name (Legal Business Name): JMRX, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S MAIN ST
BOURBON IN
46504-1649
US

IV. Provider business mailing address

101 S MAIN ST
BOURBON IN
46504-1649
US

V. Phone/Fax

Practice location:
  • Phone: 574-342-5605
  • Fax: 574-342-5605
Mailing address:
  • Phone: 574-342-5605
  • Fax: 574-342-5605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60005472A
License Number StateIN

VIII. Authorized Official

Name: MR. JOHN M REICHERT
Title or Position: PRESIDENT
Credential: RPH, MPA
Phone: 574-342-5605