Healthcare Provider Details

I. General information

NPI: 1609881234
Provider Name (Legal Business Name): J HORN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E. GREEN ST
OLEAN NY
14760-3641
US

IV. Provider business mailing address

111 E GREEN ST
OLEAN NY
14760-3641
US

V. Phone/Fax

Practice location:
  • Phone: 716-376-6337
  • Fax: 716-372-2634
Mailing address:
  • Phone: 716-376-6337
  • Fax: 716-372-2634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number023822
License Number StateNY

VIII. Authorized Official

Name: MR. JOSHUA GUENTHER HORN
Title or Position: OWNER
Credential: RPH
Phone: 716-376-6337