MEDICARE: JJS PHARMACY 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336M0003X	Managed Care Organization Pharmacy
3	333600000X	Pharmacy
4	3336C0003X	Community/Retail Pharmacy	47312	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2113793	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750478665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JJS PHARMACY LLC

Provider Business Mailing Address
First Line	:	21010 GOLDEN SPRINGS DR
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91789-3831
Country	:	US
Telephone Number	:	909-595-4003
Fax Number	:	909-595-1354

Provider Business Practice Location Address
First Line	:	21010 GOLDEN SPRINGS DR
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91789-3831
Country	:	US
Telephone Number	:	909-595-4003
Fax Number	:	909-598-2161

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN LEE
Credential	:	RPH
Telephone Number	:	909-595-4003

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	09/05/2013

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Directions to “JJS PHARMACY LLC ” Practice Location

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