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General NPI Number Information
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NPI Number | 1619502168
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Entity Type | Organization
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Legal Business Name | JJEL,LLC
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Dates
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Enumeration Date | 03/05/2020
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Last Update Date | 03/05/2020
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Provider Practice Location Address
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Address Line | 1500 CURVE CREST BLVD W
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City | STILLWATER
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State | MN
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Zip | 55082-6040
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Country | US
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Telephone | 651-430-4670
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Fax | 651-430-4671
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Provider Business Mailing Address
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Address Line | 12508 JODY AVE N
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City | HUGO
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State | MN
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Zip | 55038-9419
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Country | US
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Telephone | 651-439-2825
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT/PHARMACIST
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Name | DR. JIM POLUCHA
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Credential | PHARM.D, BSPHARM
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Telephone | 651-430-4670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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