Healthcare Provider Details

I. General information

NPI: 1275601072
Provider Name (Legal Business Name): JR PHARMACY LLC 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SOUTHLAND SHOPPING CTR
TERRE HAUTE IN
47802-3943
US

IV. Provider business mailing address

1238 S 3RD ST STE C
TERRE HAUTE IN
47802-0018
US

V. Phone/Fax

Practice location:
  • Phone: 812-232-6655
  • Fax: 812-232-6588
Mailing address:
  • Phone: 812-234-8305
  • Fax: 812-234-0225

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 Number60005646A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. TERRY J WARREN
Title or Position: PRESIDENT
Credential:
Phone: 765-828-1003