MEDICARE: J.B.M., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PP414559L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3964106	OTHER	PA	NCPDP #

General Provider Information

NPI Number	:	1043291487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J.B.M., INC.

Provider Business Mailing Address
First Line	:	1121 BETHLEHEM PIKE
Second Line	:	SUITE 40
City	:	SPRING HOUSE
State	:	PA
Zip	:	19477-1102
Country	:	US
Telephone Number	:	215-646-1691
Fax Number	:	215-646-1963

Provider Business Practice Location Address
First Line	:	1121 BETHLEHEM PIKE
Second Line	:	SUITE 40
City	:	SPRING HOUSE
State	:	PA
Zip	:	19477-1102
Country	:	US
Telephone Number	:	215-646-1691
Fax Number	:	215-646-1963

Authorized Official
Title or Position	:	PRES./PHARMACY MANAGER
Name	:	MR. JOHN A. MCVAN III
Credential	:	R.PH.
Telephone Number	:	215-646-1691

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	11/21/2008

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