Healthcare Provider Details

I. General information

NPI: 1669579595
Provider Name (Legal Business Name): JAYSIX ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 WYOMING BLVD NE STE 7B
ALBUQUERQUE NM
87109-4887
US

IV. Provider business mailing address

7120 WYOMING BLVD NE STE 7B
ALBUQUERQUE NM
87109-4887
US

V. Phone/Fax

Practice location:
  • Phone: 505-346-0533
  • Fax: 505-346-0532
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN ARNETT
Title or Position: OWNER
Credential:
Phone: 505-346-0533