# JAC PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Farmacia Latina
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679518781
- **Authorized official:** MR. JOSE CAMPON JD (LEGAL)
- **Authorized official phone:** (516) 523-6948

## Contact information

- **Practice address:** 9315 ROOSEVELT AVE, JACKSON HEIGHTS, NY 11372-7943
- **Practice address phone:** (718) 478-6863
- **Practice address fax:** (718) 478-0093
- **Mailing address:** 9315 ROOSEVELT AVE, JACKSON HEIGHTS, NY 11372-7943
- **Mailing address phone:** (718) 478-7968
- **Mailing address fax:** (718) 478-7969

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 018088 | NY | Yes |
| 3336C0003X | Community/Retail Pharmacy | 018088 | NY | — |

## Other

- **Enumeration date:** 06/20/2006
- **Last updated:** 08/13/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00824075 | — | NY |
| 01 | — | 3379511 | NCPDP | — |