Provider Demographics
NPI:1083129175
Name:JAY CARE PHARMACY LLC
Entity Type:Organization
Organization Name:JAY CARE PHARMACY LLC
Other - Org Name:JAY CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT/AO
Authorized Official - Prefix:
Authorized Official - First Name:SUSHEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JANGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-503-9927
Mailing Address - Street 1:1212 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3609
Mailing Address - Country:US
Mailing Address - Phone:850-640-4810
Mailing Address - Fax:850-640-4329
Practice Address - Street 1:1212 W 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3609
Practice Address - Country:US
Practice Address - Phone:850-640-4810
Practice Address - Fax:850-640-4329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FL310793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175151OtherPK