MEDICARE: J & J PHARMACY

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	183700000X	Pharmacy Technician	22873	TX

General Provider Information

NPI Number	:	1194852863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J & J PHARMACY

Provider Business Mailing Address
First Line	:	PO BOX 2501
Second Line	:	1811 HWY 87
City	:	CRYSTAL BEACH
State	:	TX
Zip	:	77650-2501
Country	:	US
Telephone Number	:	409-684-6337
Fax Number	:	409-684-3669

Provider Business Practice Location Address
First Line	:	1811 HWY 87
Second Line	:
City	:	CRYSTAL BEACH
State	:	TX
Zip	:	77650-2501
Country	:	US
Telephone Number	:	409-684-6337
Fax Number	:	409-684-3669

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. GAYLE R JOHNSTON
Credential	:
Telephone Number	:	409-684-6337

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	09/11/2007

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