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General NPI Number Information
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NPI Number | 1730206103
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Entity Type | Organization
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Legal Business Name | JCB LABORATORY LLC
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 7335 W 33RD ST N
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City | WICHITA
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State | KS
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Zip | 67205-9368
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Country | US
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Telephone | 316-773-0405
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Fax | 316-773-0406
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Provider Business Mailing Address
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Address Line | 7335 W 33RD ST N
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City | WICHITA
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State | KS
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Zip | 67205-9368
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Country | US
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Telephone | 316-773-0405
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Fax | 316-773-0406
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Authorized Official
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Title or Position | COO
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Name | KENT RICHARDSON
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Credential | PHARMD
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Telephone | 316-773-0405
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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 | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 2-13016
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License Number State | KS
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