Provider Demographics
NPI:1548960453
Name:JK PHARMACY INC
Entity type:Organization
Organization Name:JK PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-464-0300
Mailing Address - Street 1:5562 PHILADELPHIA ST STE 110
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2482
Mailing Address - Country:US
Mailing Address - Phone:909-464-0300
Mailing Address - Fax:909-285-0991
Practice Address - Street 1:5562 PHILADELPHIA ST STE 110
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2482
Practice Address - Country:US
Practice Address - Phone:909-464-0300
Practice Address - Fax:909-285-0991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA339274Medicaid