# JAC STORES INC

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

## Provider details

- **NPI number:** 1902817406
- **Authorized official:** DAVID FALK (PRESIDENT & OWNER)
- **Authorized official phone:** (217) 362-6226

## Contact information

- **Practice address:** 105 E JACKSON ST, VIRDEN, IL 62690-1450
- **Practice address phone:** (217) 965-4926
- **Practice address fax:** (217) 965-5620
- **Mailing address:** PO BOX 3040, DECATUR, IL 62524-3040
- **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 | 054005155 | IL | Yes |

## Other

- **Enumeration date:** 08/10/2006
- **Last updated:** 02/21/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2016694 | PK | — |