=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174111546
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J&B PHARMACY SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/01/2021
-----------------------------------------------------
Last Update Date | 09/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50496 PONTIAC TRL STE 1500
-----------------------------------------------------
City | WIXOM
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48393-2088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-611-2941
-----------------------------------------------------
Fax | 888-611-2942
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50496 PONTIAC TRL STE 1500
-----------------------------------------------------
City | WIXOM
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48393-2088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-611-2941
-----------------------------------------------------
Fax | 888-611-2942
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER
-----------------------------------------------------
Name | KELLIE MARIE VILE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-611-2941
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336M0002X
-----------------------------------------------------
Taxonomy Name | Mail Order Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------