Basic Information
| Provider Information | |||||||||
| NPI: | 1891450862 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JANUS RX LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3480 EASTERN BLVD # 302 | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361161700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3348194500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 216 N WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | BUTLER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 160015241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242822312 | ||||||||
| FaxNumber: | 7242821950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2021 | ||||||||
| LastUpdateDate: | 05/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | GREEN | ||||||||
| AuthorizedOfficialFirstName: | JANUARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP, HR | ||||||||
| AuthorizedOfficialTelephone: | 3348194511 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336L0003X | Y | Suppliers | Pharmacy | Long Term Care Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | PP483038 | 01 | PA | STATE OF PA | OTHER | 103950877-0001 | 05 | PA | MEDICAID | FJ0939302 | 01 | DEA | OTHER |