Organization
JAC STORES INC
Active
Other names
SAV MOR PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID FALK (PRESIDENT & OWNER)
(217) 362-6226
Entity
Organization
Contact information
Practice address
110 E STATE ST, NOKOMIS, IL 62075-1340
(217) 563-8346
(217) 563-2418
Mailing address
2245 W MOUND RD, DECATUR, IL 62526-9367
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054006164
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017269
PK
—
Enumeration date
08/10/2006
Last updated
08/06/2024
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