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General NPI Number Information
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NPI Number | 1689028631
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Entity Type | Organization
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Legal Business Name | JAYS HUNTING PARK PHARMACY LLC
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Dates
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Enumeration Date | 04/15/2016
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Last Update Date | 05/13/2016
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Provider Practice Location Address
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Address Line | 2001 W HUNTING PARK AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19140-2813
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Country | US
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Telephone | 215-226-0140
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Fax | 215-226-2520
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Provider Business Mailing Address
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Address Line | 2001 W HUNTING PARK AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19140-2813
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Country | US
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Telephone | 215-410-4545
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PHARMACIST
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Name | JARROD MACKLIN
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Credential |
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Telephone | 215-410-4545
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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 |
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License Number State |
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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 | PP482639
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License Number State | PA
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