Healthcare Provider Details

I. General information

NPI: 1992853550
Provider Name (Legal Business Name): L&J PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 05/20/2023
Certification Date: 05/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 S MAIN ST
ROGERSVILLE MO
65742-9361
US

IV. Provider business mailing address

317 S MAIN ST
ROGERSVILLE MO
65742-9361
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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2007000107
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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