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
Fax: (208) 245-5004
Website:
Authorized official contact:
Name: Darley, Colt PHARMD

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619001187 NPPES
Idaho Other 1303483 NCPDP
Idaho MEDICAID 002494500 NCPDP
Idaho MEDICAID 002494400 NCPDP

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