Provider Demographics
NPI:1720097397
Name:JEAN PIERRE JEAN INC
Entity type:Organization
Organization Name:JEAN PIERRE JEAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-957-6039
Mailing Address - Street 1:3015 W 183RD STREET
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430
Mailing Address - Country:US
Mailing Address - Phone:708-957-6039
Mailing Address - Fax:708-957-5073
Practice Address - Street 1:3015 W 183RD STREET
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430
Practice Address - Country:US
Practice Address - Phone:708-957-6039
Practice Address - Fax:708-957-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL032005145333600000X
IL054013140333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1466590OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1147170001OtherMEDICARE NUMBER
1147170001OtherMEDICARE NUMBER
1466590OtherOTHER ID NUMBER-COMMERCIAL NUMBER