Jac Pharmacy Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

018088 Issued in NY

Legal business name

JAC PHARMACY INC

Practice address

9315 Roosevelt Ave
Jackson Heights, NY 11372-7943

Phone

(718) 478-6863

Fax

(718) 478-0093

NPI assigned

Jun 20, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Jose Campon, JD

Title

Legal

Phone

(516) 523-6948

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Farmacia Latina Doing business as

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502582400000",
    "number": "1679518781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9315 ROOSEVELT AVE",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113727943",
            "telephone_number": "718-478-7968",
            "fax_number": "718-478-7969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9315 ROOSEVELT AVE",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113727943",
            "telephone_number": "718-478-6863",
            "fax_number": "718-478-0093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAC PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2017-08-13",
        "status": "A",
        "authorized_official_last_name": "CAMPON",
        "authorized_official_first_name": "JOSE",
        "authorized_official_title_or_position": "LEGAL",
        "authorized_official_telephone_number": "516-523-6948",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "018088",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "018088",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00824075",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3379511",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Farmacia Latina",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jackson Heights Dental Care

• Pharmacy in Jackson Heights, NY
• Providers in Jackson Heights, NY by specialty
• Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2017; 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.