Provider Demographics
NPI:1710044748
Name:LJS DISTRIBUTORS INC.
Entity type:Organization
Organization Name:LJS DISTRIBUTORS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:MARCUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-395-5718
Mailing Address - Street 1:311 JUDGES RD STE 8F
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3645
Mailing Address - Country:US
Mailing Address - Phone:910-395-5718
Mailing Address - Fax:910-395-5720
Practice Address - Street 1:311 JUDGES RD STE 8F
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3645
Practice Address - Country:US
Practice Address - Phone:910-395-5718
Practice Address - Fax:910-395-5720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3516251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health