Provider Demographics
NPI:1093887879
Name:CA & JL ENTERPRISES INC
Entity type:Organization
Organization Name:CA & JL ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-982-9433
Mailing Address - Street 1:PO BOX 1408
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-1408
Mailing Address - Country:US
Mailing Address - Phone:501-982-9433
Mailing Address - Fax:501-982-4881
Practice Address - Street 1:343 S JAMES ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4315
Practice Address - Country:US
Practice Address - Phone:501-982-9433
Practice Address - Fax:501-843-2758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AR728373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0417332OtherOTHER ID NUMBER-COMMERCIAL NUMBER
AR0417332OtherNCPDP
AR154888407Medicaid
AR157551716Medicaid
AR157551716Medicaid
ARBM7242922OtherDEA
AR157551716Medicaid