# JAC STORES INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BERTRAM PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285645788
- **Authorized official:** DAVID FALK (PRESIDENT & OWNER)
- **Authorized official phone:** (217) 362-6226

## Contact information

- **Practice address:** 1300 N ALLEN ST, ROBINSON, IL 62454-1090
- **Practice address phone:** (618) 544-2167
- **Practice address fax:** (618) 544-9298
- **Mailing address:** 2245 W MOUND RD, DECATUR, IL 62526-9367
- **Mailing address phone:** (217) 362-6226
- **Mailing address fax:** (217) 362-6241

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054015383 | IL | Yes |

## Other

- **Enumeration date:** 08/10/2006
- **Last updated:** 02/20/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2023327 | PK | — |