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
59 CEDAR SQ, CLINTON, IL 61727-2201
(217) 935-0315
(217) 935-0319
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054018054
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487443
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/06/2012
Last updated
02/22/2013
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