Organization
JEBS INC
Active
Other names
Medicap Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER STEVEN NUCKOLS RPH (OWNER PHARMACIST)
(540) 772-0605
Entity
Organization
Contact information
Practice address
4375 BRAMBLETON AVE, ROANOKE, VA 24018-3404
(540) 772-0605
(540) 772-0601
Mailing address
4375 BRAMBLETON AVE, ROANOKE, VA 24018-3404
(540) 772-0605
(540) 772-0601
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
0201003350
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4829909
NCPDP #
VA
05
—
8508399
—
VA
Enumeration date
11/22/2005
Last updated
03/07/2023
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