Provider Demographics
NPI:1699258947
Name:MJRX III, LLC
Entity type:Organization
Organization Name:MJRX III, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCHERHANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-881-4601
Mailing Address - Street 1:7209 JEFFERSON ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4307
Mailing Address - Country:US
Mailing Address - Phone:505-881-4601
Mailing Address - Fax:
Practice Address - Street 1:151 S WALNUT ST STE A5
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-2613
Practice Address - Country:US
Practice Address - Phone:575-288-1412
Practice Address - Fax:833-247-2794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy