Organization
JKP PHARMACY LLC
Active
Other names
Village Pharmacy of Fruitport
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES PANCY (OWNER)
(231) 865-3345
Entity
Organization
Contact information
Practice address
10 S 3RD AVE, FRUITPORT, MI 49415-8945
(231) 865-3345
(231) 865-1255
Mailing address
PO BOX 241, FRUITPORT, MI 49415-0241
(231) 865-3345
(231) 865-1255
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301011055
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922541168
—
MI
01
—
2166727
PK
—
Enumeration date
11/21/2016
Last updated
01/08/2019
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