MEDICARE: JBM 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	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336L0003X	Long Term Care Pharmacy
4	3336C0003X	Community/Retail Pharmacy	8824	SC

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	2092192	OTHER		PK

General Provider Information

NPI Number	:	1902802531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JBM LLC

Provider Business Mailing Address
First Line	:	822 E LIBERTY ST STE B
Second Line	:
City	:	YORK
State	:	SC
Zip	:	29745-3501
Country	:	US
Telephone Number	:	803-628-7934
Fax Number	:	803-628-4194

Provider Business Practice Location Address
First Line	:	822 E LIBERTY ST STE B
Second Line	:
City	:	YORK
State	:	SC
Zip	:	29745-3501
Country	:	US
Telephone Number	:	803-628-7934
Fax Number	:	803-628-4194

Authorized Official
Title or Position	:	OWNER PIC
Name	:	DEBORAH BOWERS
Credential	:	PHARMD
Telephone Number	:	803-628-7934

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	09/03/2019

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Directions to “JBM LLC ” Practice Location

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