Healthcare Provider Details

I. General information

NPI: 1538166384
Provider Name (Legal Business Name): JGS PHARMACIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 W COLLEGE AVE
SANTA ROSA CA
95401-5059
US

IV. Provider business mailing address

1055 W COLLEGE AVE SUITE C
SANTA ROSA CA
95401-5059
US

V. Phone/Fax

Practice location:
  • Phone: 707-575-1313
  • Fax: 707-575-0104
Mailing address:
  • Phone: 707-575-1313
  • Fax: 707-575-0104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY45936
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARK GUTTORMSEN
Title or Position: V.P., OWNER, PIC
Credential:
Phone: 707-575-1313