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General NPI Number Information
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NPI Number | 1669613683
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Entity Type | Organization
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Legal Business Name | JLT PHARMVENTURE INC
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Dates
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Enumeration Date | 03/20/2009
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Last Update Date | 03/20/2009
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Provider Practice Location Address
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Address Line | 843 AUTO CENTER DR SUITE C
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City | PALMDALE
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State | CA
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Zip | 93551-4489
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Country | US
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Telephone | 661-224-9317
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Fax |
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Provider Business Mailing Address
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Address Line | 843 AUTO CENTER DR SUITE C
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City | PALMDALE
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State | CA
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Zip | 93551-4489
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Country | US
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Telephone | 661-224-9317
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOHN THAM
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Credential |
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Telephone | 661-224-9317
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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 | PENDING
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License Number State | CA
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