NPIMap

Organization Active NPI

Jac Stores Inc

Doing business as Bertram Pharmacy LTC

  • Long Term Care Pharmacy
  • Robinson, IL
National Provider Identifier
1760227474
Registry record updated Jun 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
JAC STORES INC
Doing business as
Bertram Pharmacy LTC
Practice address
1300 N Allen St
Robinson, IL 62454-1090
Phone
(217) 433-6226
Fax
(618) 544-9298
NPI assigned
Jun 26, 2024
Last updated
Jun 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2024

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

Authorized official

Name
David Falk
Title
Owner
Phone
(217) 362-6226

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X NU Primary

Addresses

Primary practice location

1300 N Allen St
Robinson, IL 62454-1090

Mailing address

2245 W Mound Rd
Decatur, IL 62526-9367
Phone (217) 362-6226

Other names 1

  • Bertram Pharmacy LTC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
J a C Stores Inc15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

1300 N Allen St
Robinson, IL 62454
Phone (217) 433-6226

NPI Registry JSON

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

{
    "created_epoch": "1719360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719360000000",
    "number": "1760227474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2245 W MOUND RD",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625269367",
            "telephone_number": "217-362-6226",
            "fax_number": "217-362-6241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N ALLEN ST",
            "city": "ROBINSON",
            "state": "IL",
            "postal_code": "624541090",
            "telephone_number": "217-433-6226",
            "fax_number": "618-544-9298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAC STORES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-26",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A",
        "authorized_official_last_name": "FALK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-362-6226"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bertram Pharmacy LTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Robinson, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2024; 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.