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General NPI Number Information
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NPI Number | 1679518781
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Entity Type | Organization
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Legal Business Name | JAC PHARMACY INC
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 08/13/2017
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Provider Practice Location Address
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Address Line | 9315 ROOSEVELT AVE
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7943
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Country | US
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Telephone | 718-478-6863
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Fax | 718-478-0093
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Provider Business Mailing Address
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Address Line | 9315 ROOSEVELT AVE
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7943
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Country | US
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Telephone | 718-478-7968
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Fax | 718-478-7969
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Authorized Official
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Title or Position | LEGAL
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Name | MR. JOSE CAMPON
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Credential | JD
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Telephone | 516-523-6948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 018088
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 018088
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License Number State | NY
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