Provider Demographics
NPI:1447724125
Name:TJD ENTERPRISES LLC
Entity type:Organization
Organization Name:TJD ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DOEHRING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:618-327-3214
Mailing Address - Street 1:143 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-1430
Mailing Address - Country:US
Mailing Address - Phone:618-327-3214
Mailing Address - Fax:
Practice Address - Street 1:143 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62263-1430
Practice Address - Country:US
Practice Address - Phone:618-327-3214
Practice Address - Fax:618-327-9786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy