Healthcare Provider Details

I. General information

NPI: 1083035760
Provider Name (Legal Business Name): L&J PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S MAIN ST STE N-2
ROGERSVILLE MO
65742-9361
US

IV. Provider business mailing address

PO BOX 260
ROGERSVILLE MO
65742-0260
US

V. Phone/Fax

Practice location:
  • Phone: 417-753-7774
  • Fax: 417-753-7786
Mailing address:
  • Phone: 417-753-7774
  • Fax: 417-753-7786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number2013045671
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JIM COKER
Title or Position: OWNER
Credential:
Phone: 417-459-1436