Organization
JAC STORES INC
Active
Other names
BERTRAM PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID FALK (PRESIDENT & OWNER)
(217) 362-6226
Entity
Organization
Contact information
Practice address
1300 N ALLEN ST, ROBINSON, IL 62454-1090
(618) 544-2167
(618) 544-9298
Mailing address
2245 W MOUND RD, DECATUR, IL 62526-9367
(217) 362-6226
(217) 362-6241
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054015383
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023327
PK
—
Enumeration date
08/10/2006
Last updated
02/20/2017
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