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General NPI Number Information
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NPI Number | 1083935233
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Entity Type | Organization
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Legal Business Name | JAT PHARMACY, LLC
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Dates
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Enumeration Date | 06/22/2010
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 805 BURTON BOULEVARD SUITE A
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City | DEFOREST
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State | WI
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Zip | 53532
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Country | US
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Telephone | 877-490-3577
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Fax | 877-490-3576
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Provider Business Mailing Address
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Address Line | 805 BURTON BOULEVARD SUITE A
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City | DEFOREST
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State | WI
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Zip | 53532
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Country | US
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Telephone | 877-490-3577
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Fax | 877-490-3576
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY/PHARMACIST IN
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Name | WILLIAM A. BARTKOWIAK
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Credential | R.PH., MBA
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Telephone | 877-490-3577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | 9015-42
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License Number State | WI
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