Healthcare Provider Details

I. General information

NPI: 1285095331
Provider Name (Legal Business Name): JANKI PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MAIN ST
CLAY CITY IN
47841-1332
US

IV. Provider business mailing address

1635 N 3RD ST
TERRE HAUTE IN
47804-4044
US

V. Phone/Fax

Practice location:
  • Phone: 812-939-2173
  • Fax: 812-939-2508
Mailing address:
  • Phone: 812-231-1040
  • Fax: 812-231-1044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60006563A
License Number StateIN

VIII. Authorized Official

Name: ALPESH PATEL
Title or Position: PRESIDENT
Credential:
Phone: 812-240-7405