Jacks Pharmacy Inc

LBN: Jacks Pharmacy Inc
Jacks Pharmacy Inc is an health care organization with primary practice located at 103 E College Ave , St Maries ID 83861-2247. The organization recently has only one registered license in Suppliers / Community/Retail Pharmacy, which is considered as the primary health care specialty. Jacks Pharmacy Inc can be contacted via phone (208) 245-4578, or through Darley, Colt via phone (208) 245-4578.

Contact Information

Primary practice address
103 E College Ave St Maries ID 83861-2247
Phone: (208) 245-4578
Fax: (208) 245-5004
Website:
Map and Directions
Authorized official contact:
Name: Darley, Colt
Phone: (208) 245-4578

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Community/Retail Pharmacy 3336C0003X 1368CP Idaho

Profile Details

NPI number 1518967710
LBN Legal business name Jacks Pharmacy Inc
DBA Doing business as
Authorized official Darley, Colt
Entity Organization
Organization subpart 1 No
Enumeration date Jul 28th, 2005
Last updated Feb 7th, 2020 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518967710 NPPES
Idaho MEDICAID 002494400
Idaho MEDICAID 002494500
Idaho Other 1303483

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