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General NPI Number Information
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NPI Number | 1821152323
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Entity Type | Organization
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Legal Business Name | JTAC2 INC
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10019 S MAIN ST # A-10
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City | HOUSTON
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State | TX
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Zip | 77025-5209
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Country | US
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Telephone | 713-667-5003
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Fax | 713-667-5030
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Provider Business Mailing Address
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Address Line | 10019 S MAIN ST # A-10
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City | HOUSTON
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State | TX
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Zip | 77025-5209
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Country | US
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Telephone | 713-667-5003
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Fax | 713-667-5030
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEFFERY K WILLIAMS
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Credential | RPH
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Telephone | 713-667-5003
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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 | 24218
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License Number State | TX
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