Provider Demographics
NPI:1447261078
Name:S AND J PHARMACY INC
Entity type:Organization
Organization Name:S AND J PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GENRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:602-257-1196
Mailing Address - Street 1:333 E VIRGINIA AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1206
Mailing Address - Country:US
Mailing Address - Phone:602-257-1196
Mailing Address - Fax:
Practice Address - Street 1:333 E VIRGINIA AVE
Practice Address - Street 2:STE 120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1206
Practice Address - Country:US
Practice Address - Phone:602-257-1196
Practice Address - Fax:602-257-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY001871332B00000X
333600000X
AZ0018713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ332800000XOtherDME SUPPLIER
AZ30410501Medicaid
0314714OtherOTHER ID NUMBER
0314714OtherOTHER ID NUMBER-COMMERCIAL NUMBER
AZ0740160001Medicare NSC