Provider Demographics
NPI:1285268987
Name:JR PHARMACY POPLAR LLC
Entity type:Organization
Organization Name:JR PHARMACY POPLAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:VENCEL
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 1:1101 POPLAR ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-4565
Practice Address - Country:US
Practice Address - Phone:812-235-7373
Practice Address - Fax:812-478-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy