Healthcare Provider Details

I. General information

NPI: 1770595407
Provider Name (Legal Business Name): CJLM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 RUSSELLVILLE RD
BOWLING GREEN KY
42101-3920
US

IV. Provider business mailing address

2305 RUSSELLVILLE RD
BOWLING GREEN KY
42101-3920
US

V. Phone/Fax

Practice location:
  • Phone: 270-796-3909
  • Fax: 270-796-4111
Mailing address:
  • Phone: 270-796-3909
  • Fax: 270-796-4111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPO6802
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number710020835
License Number StateKY

VIII. Authorized Official

Name: LAUREN C CREWS
Title or Position: PRESIDENT/PIC
Credential: PHARMD
Phone: 270-796-3909