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Organization

JACKISCH DRUG STORE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TODD ANTROBUS (OWNER)
(606) 316-2031
Entity
Organization

Contact information

Practice address
426 PAGOSA STREET, PAGOSA SPRINGS, CA 81147
(970) 264-4166
Mailing address
115 MILLS ST, OLIVE HILL, KY 41164-6800

Taxonomy

Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary

Other

Enumeration date
03/21/2018
Last updated
03/21/2018
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