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General NPI Number Information
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NPI Number | 1083075683
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Entity Type | Organization
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Legal Business Name | K3J LLC
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Dates
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Enumeration Date | 03/10/2016
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Last Update Date | 08/16/2016
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Provider Practice Location Address
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Address Line | 503 E LONDON ST
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City | BOWIE
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State | TX
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Zip | 76230-3020
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Country | US
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Telephone | 940-872-1140
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Fax | 940-872-4466
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Provider Business Mailing Address
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Address Line | 503 E LONDON ST
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City | BOWIE
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State | TX
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Zip | 76230-3020
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Country | US
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Telephone | 940-872-1140
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Fax | 940-872-4466
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | JAMES CRUMPLER
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Credential |
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Telephone | 940-872-1140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 30700
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License Number State | TX
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