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 2 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Community/Retail Pharmacy. Suppliers / Durable Medical Equipment & Medical Supplies is 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:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Durable Medical Equipment & Medical Supplies | 332B00000X | 1368CP | Idaho |
| Suppliers / Community/Retail Pharmacy | 3336C0003X |
Profile Details
| NPI number | 1619001187 |
|---|---|
| LBN Legal business name | Jacks Pharmacy Inc |
| DBA Doing business as | |
| Authorized official | Darley, Colt PHARMD |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Mar 15th, 2007 |
| Last updated | Feb 7th, 2020 - about 5 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619001187 | NPPES |
| Idaho | Other | 1303483 | NCPDP |
| Idaho | MEDICAID | 002494500 | NCPDP |
| Idaho | MEDICAID | 002494400 | NCPDP |
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