Provider Demographics
NPI:1235223645
Name:JAMMAL PHARMS INC
Entity Type:Organization
Organization Name:JAMMAL PHARMS INC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:308-234-8056
Mailing Address - Street 1:2706 2ND AVE
Mailing Address - Street 2:STE A
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-4429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2706 2ND AVE
Practice Address - Street 2:STE A
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-4429
Practice Address - Country:US
Practice Address - Phone:308-234-8056
Practice Address - Fax:308-234-8060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2816645OtherNCPDP #
NE10025044200Medicaid
NE10025044200Medicaid
NE4982620001Medicare NSC
NE099465Medicare PIN
NE2816645OtherNCPDP #