Provider Demographics
NPI:1144316191
Name:J & L COMPOUNDING INC.
Entity type:Organization
Organization Name:J & L COMPOUNDING INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:DME SPECIALIST
Authorized Official - Phone:859-684-8409
Mailing Address - Street 1:705 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-1164
Mailing Address - Country:US
Mailing Address - Phone:502-863-6774
Mailing Address - Fax:502-863-3203
Practice Address - Street 1:705 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1164
Practice Address - Country:US
Practice Address - Phone:502-863-6774
Practice Address - Fax:502-863-3203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100192730Medicaid
KY90131053Medicaid
KY45902202Medicaid
KY5403375800Medicaid