MEDICARE: MJRX III, LLC

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
2	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1699258947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MJRX III, LLC

Provider Business Mailing Address
First Line	:	7209 JEFFERSON ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4307
Country	:	US
Telephone Number	:	505-881-4601
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 S WALNUT ST STE A5
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-2613
Country	:	US
Telephone Number	:	575-288-1412
Fax Number	:	833-247-2794

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN KOCHERHANS
Credential	:
Telephone Number	:	505-881-4601

Provider Enumeration Date	:	09/12/2018
Last Update Date	:	02/25/2021

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