Provider Demographics
NPI:1548397128
Name:JAKE ENTERPRISES INC
Entity Type:Organization
Organization Name:JAKE ENTERPRISES INC
Other - Org Name:COMMUNITY PHARMACY I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRES AND MANAGING PHARM
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGGABAO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:671-646-6160
Mailing Address - Street 1:177 CHALAN PASAHERU STE C
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-4161
Mailing Address - Country:US
Mailing Address - Phone:671-646-6160
Mailing Address - Fax:671-646-6159
Practice Address - Street 1:177 CHALAN PASAHERU STE C
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-4161
Practice Address - Country:US
Practice Address - Phone:671-646-6160
Practice Address - Fax:671-646-6159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPCY0393336C0002X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5411400OtherNCPDP PROVIDER IDENTIFICATION NUMBER