Healthcare Provider Details

I. General information

NPI: 1689177552
Provider Name (Legal Business Name): JP PHARMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3534 ELECTRIC RD
ROANOKE VA
24018-4453
US

IV. Provider business mailing address

411 PARK AVE
DANVILLE VA
24541-4629
US

V. Phone/Fax

Practice location:
  • Phone: 540-339-9446
  • Fax: 540-301-3539
Mailing address:
  • Phone: 434-792-8281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201004827
License Number StateVA

VIII. Authorized Official

Name: JAY SUTHAR
Title or Position: MANAGER
Credential:
Phone: 540-339-9446