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General NPI Number Information
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NPI Number | 1891979647
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Entity Type | Organization
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Legal Business Name | JRJ SUPPLY LLC
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 132 BROWN RD
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City | BENTON
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State | LA
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Zip | 71006-4715
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Country | US
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Telephone | 318-218-5928
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Fax |
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Provider Business Mailing Address
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Address Line | 132 BROWN RD
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City | BENTON
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State | LA
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Zip | 71006-4715
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Country | US
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Telephone | 318-218-5928
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. JANET BROWN
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Credential |
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Telephone | 318-218-5928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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