MEDICARE: JAY-KISHUN ENTERPRISE 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	3336C0003X	Community/Retail Pharmacy	22047	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2097941	OTHER		PK

General Provider Information

NPI Number	:	1710945381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY-KISHUN ENTERPRISE INC

Provider Business Mailing Address
First Line	:	2524 MALL CIR
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76116-1545
Country	:	US
Telephone Number	:	817-737-7377
Fax Number	:	817-737-7388

Provider Business Practice Location Address
First Line	:	2524 MALL CIR
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76116-1545
Country	:	US
Telephone Number	:	817-737-7377
Fax Number	:	817-737-7388

Authorized Official
Title or Position	:	PIC
Name	:	KAMLESHI KURANI
Credential	:
Telephone Number	:	817-737-7377

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/13/2016

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