Provider Demographics
NPI:1063141372
Name:JR PHARMACY LLC 6
Entity type:Organization
Organization Name:JR PHARMACY LLC 6
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOWSHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-234-8305
Mailing Address - Street 1:1238 S 3RD ST STE C
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-1006
Mailing Address - Country:US
Mailing Address - Phone:812-234-8305
Mailing Address - Fax:812-234-0225
Practice Address - Street 1:607 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:WEST TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47885-1303
Practice Address - Country:US
Practice Address - Phone:812-234-8305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN60006838AOtherPHARMACY LICENSE