Provider Demographics
NPI:1902968100
Name:JAMES JOSEPH MRACEK
Entity Type:Organization
Organization Name:JAMES JOSEPH MRACEK
Other - Org Name:JOE'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:MRACEK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:334-567-5315
Mailing Address - Street 1:PO BOX 766
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36092-0766
Mailing Address - Country:US
Mailing Address - Phone:334-567-5315
Mailing Address - Fax:334-514-0291
Practice Address - Street 1:809 JACKSON TRACE
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36092
Practice Address - Country:US
Practice Address - Phone:334-567-5315
Practice Address - Fax:334-514-0291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL105635332B00000X
AL6961332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000052660Medicaid
AL0374410001Medicare NSC