Jetkat, Inc.

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

22695 Issued in NY

Legal business name

JETKAT, INC.

Practice address

66 West Ave
Canandaigua, NY 14424

Phone

(585) 396-9970

Fax

(585) 396-7264

NPI assigned

Jan 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kim Anthony Tenreiro, RPH.

Title

Secretary Jetkat Inc.

Phone

(585) 396-9970

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• DBA The Pharmacy Shop Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1093866980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 WEST AVE",
            "city": "CANANDAIGUA",
            "state": "NY",
            "postal_code": "14424",
            "telephone_number": "585-396-9970",
            "fax_number": "585-396-7264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 WEST AVE",
            "city": "CANANDAIGUA",
            "state": "NY",
            "postal_code": "14424",
            "telephone_number": "585-396-9970",
            "fax_number": "585-396-7264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JETKAT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "TENREIRO",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "SECRETARY JETKAT INC.",
        "authorized_official_telephone_number": "585-396-9970",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "022695",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NY",
            "license": "22695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP #",
            "identifier": "3395971",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01593140",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA The Pharmacy Shop",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Misselle Lavonne Jeffcoat, LPMHC, LPC, MS
• Elizabeth A Jeffery, LCSW
• Morgan Renee Jeneault, COTA/L
• Diana Jensen, RNFA
• Timothy Alan Jensen, RPA-C
• Marcia Jewell, RN
• John E Shafer
• John Estabrook
• John O. Evans, O.D,
• Leyna Johnson Nguyen, LMSW, CASAC

• Compounding Pharmacy in Canandaigua, NY
• Providers in Canandaigua, NY by specialty
• Compounding Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.