Provider Demographics
NPI:1285943464
Name:C J PHARMACYSERVICES LLC
Entity type:Organization
Organization Name:C J PHARMACYSERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENAE
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENZO LOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-466-1427
Mailing Address - Street 1:PO BOX 531
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-0531
Mailing Address - Country:US
Mailing Address - Phone:970-526-9417
Mailing Address - Fax:970-522-1432
Practice Address - Street 1:422 MAIN ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4343
Practice Address - Country:US
Practice Address - Phone:970-526-9417
Practice Address - Fax:907-522-1432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336H0001X
CO8073336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46056084Medicaid
0621866OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NE10026008400Medicaid
6505290001Medicare NSC