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General NPI Number Information
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NPI Number | 1508385477
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Entity Type | Organization
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Legal Business Name | JKW & JIRA INC.
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Dates
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Enumeration Date | 09/12/2017
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 1245 N 29TH ST STE 100
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City | BILLINGS
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State | MT
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Zip | 59101
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Country | US
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Telephone | 406-601-3392
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Fax | 877-743-0496
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Provider Business Mailing Address
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Address Line | 2900 12TH AVE N STE 110A
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City | BILLINGS
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State | MT
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Zip | 59101-7506
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Country | US
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Telephone | 406-245-6717
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Fax | 406-252-4078
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARTIN JARROD WILLEMS
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Credential | R.PH.
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Telephone | 406-601-3392
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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 | PHA-PHR-LIC-47362
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHA-PHR-LIC-47362
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License Number State | MT
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