Healthcare Provider Details

I. General information

NPI: 1447236583
Provider Name (Legal Business Name): T & J ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 ADAMS AVE
HUNTINGTON WV
25704-1322
US

IV. Provider business mailing address

2402 ADAMS AVE
HUNTINGTON WV
25704-1322
US

V. Phone/Fax

Practice location:
  • Phone: 304-429-6716
  • Fax: 304-429-1924
Mailing address:
  • Phone: 304-429-6716
  • Fax: 304-429-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberSP0550702
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberSP0550702
License Number StateWV

VIII. Authorized Official

Name: MRS. ANGELA S RONK
Title or Position: OWNER
Credential: R.PH.
Phone: 304-429-6716