Organization
JAC STORES INC
Active
Other names
SAV MOR PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID FALK (OWNER PRES)
(217) 262-6226
Entity
Organization
Contact information
Practice address
121 W NORTH AVE, FLORA, IL 62839-1613
(618) 662-9470
Mailing address
2245 W MOUND RD, DECATUR, IL 62526-9367
(217) 362-6226
(217) 362-6241
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
054016343
IL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1481504
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/19/2007
Last updated
02/13/2013
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