Provider Demographics
NPI:1902802531
Name:JBM LLC
Entity Type:Organization
Organization Name:JBM LLC
Other - Org Name:YORKVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PIC
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:803-628-7934
Mailing Address - Street 1:822 E LIBERTY ST STE B
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-3501
Mailing Address - Country:US
Mailing Address - Phone:803-628-7934
Mailing Address - Fax:803-628-4194
Practice Address - Street 1:822 E LIBERTY ST STE B
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-3501
Practice Address - Country:US
Practice Address - Phone:803-628-7934
Practice Address - Fax:803-628-4194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
SC88243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7875244Medicaid
2092192OtherPK
4558650001Medicare NSC