Provider Demographics
NPI:1225125248
Name:JEHAS PHARMACY INC
Entity Type:Organization
Organization Name:JEHAS PHARMACY INC
Other - Org Name:PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-223-1321
Mailing Address - Street 1:3716 SAN PABLO DAM RD
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-2820
Mailing Address - Country:US
Mailing Address - Phone:510-223-1321
Mailing Address - Fax:510-758-6483
Practice Address - Street 1:3716 SAN PABLO DAM RD
Practice Address - Street 2:
Practice Address - City:EL SOBRANTE
Practice Address - State:CA
Practice Address - Zip Code:94803-2820
Practice Address - Country:US
Practice Address - Phone:510-223-1321
Practice Address - Fax:510-758-6483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CAPHY343223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1999309OtherPK