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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

Details

NameValue
NPI1285268987
Enumeration Date2020-03-03
NPI TypeNPI-2 Organization
StatusActive
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
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 3336L0003X - Pharmacy - Long Term Care Pharmacy