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General NPI Number Information
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NPI Number | 1629182696
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Entity Type | Organization
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Legal Business Name | JBR ENTERPRISES INC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 112 HOUSTON AVE
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City | PERRYVILLE
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State | AR
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Zip | 72126-9451
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Country | US
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Telephone | 501-889-5111
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Fax | 501-889-5544
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Provider Business Mailing Address
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Address Line | PO BOX 435
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City | PERRYVILLE
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State | AR
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Zip | 72126-0435
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Country | US
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Telephone | 501-889-5111
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Fax | 501-889-5544
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Authorized Official
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Title or Position | MGR
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Name | JOHN ROLAND
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Credential |
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Telephone | 501-889-5111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | AR20217
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License Number State | AR
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