# J MAC DRUG INC

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

## Provider details

- **NPI number:** 1669569869
- **Authorized official:** CHRISTINA CUDAHY RPH (PHARM MGR)
- **Authorized official phone:** (503) 639-7377

## Contact information

- **Practice address:** 15685 SW 116TH AVE, KING CITY, OR 97224-2651
- **Practice address phone:** (503) 639-1171
- **Practice address fax:** (503) 620-2167
- **Mailing address:** 15685 SW 116TH AVE, KING CITY, OR 97224-2651
- **Mailing address phone:** (503) 639-1171
- **Mailing address fax:** (503) 620-2167

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 0000563CS | OR | Yes |

## Other

- **Enumeration date:** 10/07/2006
- **Last updated:** 02/21/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 123596 | — | OR |
| 01 | — | 2077240 | PK | — |