Provider Information for 1871136986
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JAY'S ROADHOUSE AND PHARMACY LLC
Other Names:Doing Business As:LYONS CORNER DRUGOrganization Subpart: NO
NPI: 1871136986
Last Updated: 2020-10-21
Certification Date: 2020-10-21
Certification Date: 2020-10-21
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1871136986 | ||||||||||||
| Enumeration Date | 2019-10-21 | ||||||||||||
| NPI Type | NPI-2 Organization | ||||||||||||
| Status | Active | ||||||||||||
| Authorized Official Information | Name: Dr. MATTHEW TODD JOHNSON Pharm.D. Title: Pharmacist/Owner Phone: 9702918813 | ||||||||||||
| Mailing Address | 42225 DEER RD STEAMBOAT SPRINGS, CO 80487-9159 United States Phone: 970-871-4596 | Fax: | ||||||||||||
| Primary Practice Address | 840 LINCOLN AVE STEAMBOAT SPRINGS, CO 80487-5005 United States Phone: 970-879-1114 | Fax:970-879-5643 | ||||||||||||
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