Healthcare Provider Details

I. General information

NPI: 1891754750
Provider Name (Legal Business Name): MJRX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7209 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4307
US

IV. Provider business mailing address

7209 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4307
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-4601
  • Fax: 505-881-4647
Mailing address:
  • Phone: 505-881-4601
  • Fax: 505-881-4647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPH00003733
License Number StateNM

VIII. Authorized Official

Name: STEPHEN KOCHERHANS
Title or Position: OWNER
Credential:
Phone: 505-881-4601