MEDICARE: JS PHARMACY LLC

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	PH23327	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2011836	OTHER		PK

General Provider Information

NPI Number	:	1649437161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JS PHARMACY LLC

Provider Business Mailing Address
First Line	:	6416 RIDGE RD
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668
Country	:	US
Telephone Number	:	727-847-2211
Fax Number	:	727-847-2212

Provider Business Practice Location Address
First Line	:	6416 RIDGE RD
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-6748
Country	:	US
Telephone Number	:	727-847-2211
Fax Number	:	727-847-2212

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	RUKAM JASSAL
Credential	:
Telephone Number	:	727-483-3923

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	08/19/2014

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Directions to “JS PHARMACY LLC ” Practice Location

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