Provider Demographics
NPI:1487156741
Name:J & C RX LLC
Entity type:Organization
Organization Name:J & C RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:NQUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-804-6605
Mailing Address - Street 1:11301 FALLBROOK #124
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065
Mailing Address - Country:US
Mailing Address - Phone:832-804-6605
Mailing Address - Fax:281-664-0084
Practice Address - Street 1:11301 FALLBROOK #124
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065
Practice Address - Country:US
Practice Address - Phone:832-804-6605
Practice Address - Fax:281-664-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX295693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000000Medicaid
2175660OtherPK