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
138 N MARKET ST, PAXTON, IL 60957-1220
(217) 379-4855
(217) 379-9068
Mailing address
PO BOX 3040, DECATUR, IL 62524-3040
(217) 362-6226
(217) 362-6241
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054014499
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1446031
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/10/2006
Last updated
10/04/2012
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