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General NPI Number Information
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NPI Number | 1164661914
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Entity Type | Organization
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Legal Business Name | JIB ENTERPRISES LLC
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 10/12/2016
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Provider Practice Location Address
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Address Line | 1590 W HORIZON RIDGE PKWY SUITE#130
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City | HENDERSON
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State | NV
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Zip | 89012-3507
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Country | US
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Telephone | 702-834-8152
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Fax | 702-834-8156
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Provider Business Mailing Address
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Address Line | 1590 W HORIZON RIDGE PKWY SUITE#130
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City | HENDERSON
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State | NV
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Zip | 89012-3507
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Country | US
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Telephone | 702-834-8152
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Fax | 702-834-8156
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | RUBINA BUTT
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Credential |
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Telephone | 702-807-2049
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PH02512
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License Number State | NV
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