MEDICARE: J AND J MUSICK 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	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	958	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2123126	OTHER		PK

General Provider Information

NPI Number	:	1306172952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J AND J MUSICK INC

Provider Business Mailing Address
First Line	:	830 4TH AVE SE STE 2
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52403-2445
Country	:	US
Telephone Number	:	319-362-8976
Fax Number	:	319-298-1669

Provider Business Practice Location Address
First Line	:	830 4TH AVE SE STE 2
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52403-2445
Country	:	US
Telephone Number	:	319-362-8976
Fax Number	:	319-298-1669

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOEY MUSICK
Credential	:
Telephone Number	:	319-362-8976

Provider Enumeration Date	:	11/02/2009
Last Update Date	:	01/18/2017

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