Healthcare Provider Details

I. General information

NPI: 1851485262
Provider Name (Legal Business Name): JKRX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 E BOULEVARD AVE
BISMARCK ND
58501-4234
US

IV. Provider business mailing address

1304 E BOULEVARD AVE
BISMARCK ND
58501-4234
US

V. Phone/Fax

Practice location:
  • Phone: 701-224-0175
  • Fax: 701-224-1285
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number761
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TANYA BROSZ
Title or Position: OWNER
Credential: PHARMD
Phone: 701-224-0175