Provider Demographics
NPI:1902678899
Name:PB & J, INC
Entity Type:Organization
Organization Name:PB & J, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:859-699-8611
Mailing Address - Street 1:813 COLONEL ANDERSON PKWY
Mailing Address - Street 2:
Mailing Address - City:HURSTBOURNE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5522
Mailing Address - Country:US
Mailing Address - Phone:859-699-8611
Mailing Address - Fax:
Practice Address - Street 1:813 COLONEL ANDERSON PKWY
Practice Address - Street 2:
Practice Address - City:HURSTBOURNE
Practice Address - State:KY
Practice Address - Zip Code:40222-5522
Practice Address - Country:US
Practice Address - Phone:859-699-8611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies