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General NPI Number Information
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NPI Number | 1992020028
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Entity Type | Organization
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Legal Business Name | JACKSON LTC PHARMACY INC.
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Dates
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Enumeration Date | 03/31/2010
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 266 N JACKSON AVE 8B
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City | SAN JOSE
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State | CA
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Zip | 95116-1606
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Country | US
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Telephone | 408-251-7009
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Fax | 404-251-7007
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Provider Business Mailing Address
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Address Line | 266 N JACKSON AVE 8B
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City | SAN JOSE
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State | CA
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Zip | 95116-1606
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SRINIVAS REDDY KATPELLY
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Credential |
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Telephone | 415-464-9777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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