Organization
JAC STORES INC
Active
Other names
Sav Mor Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID FALK (OWNER/PRESIDENT/AO)
(217) 362-6226
Entity
Organization
Contact information
Practice address
1110 N TOPPER DR, MOUNT PULASKI, IL 62548-1401
(217) 362-6226
(217) 792-5635
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
054020026
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2159739
PK
—
Enumeration date
05/09/2016
Last updated
10/12/2016
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