MEDICARE: JSB GROUP 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	3336C0003X	Community/Retail Pharmacy	19406169	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2615752	OTHER	NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1982719910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JSB GROUP LLC

Provider Business Mailing Address
First Line	:	12130 LADUE RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8121
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2386 N HIGHWAY 67
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-2034
Country	:	US
Telephone Number	:	314-921-7700
Fax Number	:	314-921-3520

Authorized Official
Title or Position	:	MEDICAID MEDICARE BILLING SPEC
Name	:	SUSAN GUINN
Credential	:	RPH
Telephone Number	:	314-993-6000

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	10/16/2008

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Directions to “JSB GROUP LLC ” Practice Location

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