MEDICARE: JEHAS PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy	PHY34322	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1999309	OTHER		PK

General Provider Information

NPI Number	:	1225125248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEHAS PHARMACY INC

Provider Business Mailing Address
First Line	:	3716 SAN PABLO DAM RD
Second Line	:
City	:	EL SOBRANTE
State	:	CA
Zip	:	94803-2820
Country	:	US
Telephone Number	:	510-223-1321
Fax Number	:	510-758-6483

Provider Business Practice Location Address
First Line	:	3716 SAN PABLO DAM RD
Second Line	:
City	:	EL SOBRANTE
State	:	CA
Zip	:	94803-2820
Country	:	US
Telephone Number	:	510-223-1321
Fax Number	:	510-758-6483

Authorized Official
Title or Position	:	MANAGER
Name	:	LORI DOBBS
Credential	:
Telephone Number	:	510-223-1321

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	09/10/2015

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