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
105 E JACKSON ST, VIRDEN, IL 62690-1450
(217) 965-4926
(217) 965-5620
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
054005155
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2016694
PK
—
Enumeration date
08/10/2006
Last updated
02/21/2017
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