=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497928832
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JSK FAMILY PHARMACIES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2008
-----------------------------------------------------
Last Update Date | 04/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8010 2ND ST
-----------------------------------------------------
City | PARAMOUNT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90723-3404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-531-1313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8010 2ND ST
-----------------------------------------------------
City | PARAMOUNT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90723-3404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-531-1313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MINESH BHAKTA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 562-531-1313
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY 50389
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------