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General NPI Number Information
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NPI Number | 1720097397
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Entity Type | Organization
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Legal Business Name | JEAN PIERRE JEAN INC
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 3015 W 183RD STREET
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City | HOMEWOOD
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State | IL
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Zip | 60430
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Country | US
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Telephone | 708-957-6039
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Fax | 708-957-5073
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Provider Business Mailing Address
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Address Line | 3015 W 183RD STREET
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City | HOMEWOOD
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State | IL
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Zip | 60430
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Country | US
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Telephone | 708-957-6039
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Fax | 708-957-5073
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | MRS. ELMA J JEAN
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Credential |
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Telephone | 708-957-6039
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 054013140
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 032005145
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License Number State | IL
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