Provider Demographics
NPI:1255677498
Name:JAHEMA ENTERPRISE INC
Entity Type:Organization
Organization Name:JAHEMA ENTERPRISE INC
Other - Org Name:REDDICK DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYESH
Authorized Official - Middle Name:G
Authorized Official - Last Name:PAMBHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-591-1116
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:REDDICK
Mailing Address - State:FL
Mailing Address - Zip Code:32686-0215
Mailing Address - Country:US
Mailing Address - Phone:352-591-1116
Mailing Address - Fax:352-591-3003
Practice Address - Street 1:15320 NW GAINESVILLE ROAD
Practice Address - Street 2:
Practice Address - City:REDDICK
Practice Address - State:FL
Practice Address - Zip Code:32686
Practice Address - Country:US
Practice Address - Phone:352-591-1116
Practice Address - Fax:352-591-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherPHARMACY
FL6885320001Medicare NSC