Provider Information for 1285268987
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JR PHARMACY POPLAR LLC
Organization Subpart: NO
NPI: 1285268987
Last Updated: 2020-03-03
Certification Date: 2020-03-03
Certification Date: 2020-03-03
Details
Name | Value | ||||||||
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NPI | 1285268987 | ||||||||
Enumeration Date | 2020-03-03 | ||||||||
NPI Type | NPI-2 Organization | ||||||||
Status | Active | ||||||||
Authorized Official Information | Name: RONALD J VENCEL Title: President/Owner Phone: 8122348305 | ||||||||
Mailing Address | 1238 S 3RD ST STE C TERRE HAUTE, IN 47802-1006 United States Phone: 812-234-8305 | Fax:812-234-0225 | ||||||||
Primary Practice Address | 1101 POPLAR ST TERRE HAUTE, IN 47807-4565 United States Phone: 812-235-7373 | Fax:812-478-0459 | ||||||||
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