Provider Demographics
NPI:1417581943
Name:JIKE LLC
Entity Type:Organization
Organization Name:JIKE LLC
Other - Org Name:SQUARE CARE MEDICAL & PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IHEKE
Authorized Official - Middle Name:O
Authorized Official - Last Name:EKEYA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:503-473-6316
Mailing Address - Street 1:717 NW 120TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2495
Mailing Address - Country:US
Mailing Address - Phone:360-583-4633
Mailing Address - Fax:360-258-0597
Practice Address - Street 1:8600 E MILL PLAIN BLVD STE A
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2055
Practice Address - Country:US
Practice Address - Phone:360-583-4633
Practice Address - Fax:360-258-0597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-24
Last Update Date:2022-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No3336C0004XSuppliersPharmacyCompounding Pharmacy