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General NPI Number Information
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NPI Number | 1871658922
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Entity Type | Organization
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Legal Business Name | JACKISCH DRUG, INC.
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 426 PAGOSA ST.
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-0000
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Country | US
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Telephone | 970-264-4166
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Fax | 970-264-3289
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Provider Business Mailing Address
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Address Line | PO BOX 120
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-0120
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Country | US
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Telephone | 970-264-4166
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Fax | 970-355-6448
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DEBBIE J NOCITA
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Credential |
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Telephone | 970-264-4166
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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 | 10000001
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License Number State | CO
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