Organization
JAC PHARMACY INC
Active
Other names
Farmacia Latina
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSE CAMPON JD (LEGAL)
(516) 523-6948
Entity
Organization
Contact information
Practice address
9315 ROOSEVELT AVE, JACKSON HEIGHTS, NY 11372-7943
(718) 478-6863
(718) 478-0093
Mailing address
9315 ROOSEVELT AVE, JACKSON HEIGHTS, NY 11372-7943
(718) 478-7968
(718) 478-7969
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
018088
NY
3336C0003X
Community/Retail Pharmacy
018088
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00824075
—
NY
01
—
3379511
NCPDP
—
Enumeration date
06/20/2006
Last updated
08/13/2017
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