Provider Demographics
NPI:1578585410
Name:JAJCO INC.
Entity Type:Organization
Organization Name:JAJCO INC.
Other - Org Name:ANCHOR DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:JAJEH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:650-827-7105
Mailing Address - Street 1:481 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3635
Mailing Address - Country:US
Mailing Address - Phone:650-827-7105
Mailing Address - Fax:650-588-1730
Practice Address - Street 1:481 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-3635
Practice Address - Country:US
Practice Address - Phone:650-827-7105
Practice Address - Fax:650-588-1730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY4153303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY415330Medicaid
CAPHY415330Medicaid