Healthcare Provider Details

I. General information

NPI: 1487564837
Provider Name (Legal Business Name): MJ TECH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 REYNOLDA RD
WINSTON SALEM NC
27104-1018
US

IV. Provider business mailing address

73 RALPH AVE
BROOKLYN NY
11221-4109
US

V. Phone/Fax

Practice location:
  • Phone: 314-639-9213
  • Fax:
Mailing address:
  • Phone: 314-639-9213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARAGRRET JARRET
Title or Position: MANAGER
Credential:
Phone: 314-639-9213