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General NPI Number Information
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NPI Number | 1770911414
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Entity Type | Organization
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Legal Business Name | JAYS HOMETOWN PHARMACY LLC
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Dates
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Enumeration Date | 10/15/2013
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 612 S STERLING ST
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City | MORGANTON
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State | NC
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Zip | 28655-3575
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Country | US
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Telephone | 828-438-1866
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Fax | 828-438-1867
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Provider Business Mailing Address
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Address Line | 612 S STERLING ST
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City | MORGANTON
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State | NC
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Zip | 28655-3575
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Country | US
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Telephone | 828-438-1866
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Fax | 828-438-1867
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Authorized Official
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Title or Position | PHARMACY OWNER/MANAGER
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Name | JOHN MARTINO
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Credential |
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Telephone | 828-443-1745
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 11658
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License Number State | NC
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