MEDICARE: JAC PHARMACY CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1508382094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAC PHARMACY CORP

Provider Business Mailing Address
First Line	:	17350 S DIXIE HWY
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33157-4319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17350 S DIXIE HWY
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33157-4319
Country	:	US
Telephone Number	:	786-842-3196
Fax Number	:	786-842-3927

Authorized Official
Title or Position	:	SECRETARY
Name	:	ADRIA CESPEDES HIDALGO
Credential	:
Telephone Number	:	786-842-3196

Provider Enumeration Date	:	08/17/2017
Last Update Date	:	08/22/2017

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Directions to “JAC PHARMACY CORP ” Practice Location

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