Provider Demographics
NPI:1588825343
Name:J MAC DRUG INC
Entity Type:Organization
Organization Name:J MAC DRUG INC
Other - Org Name:MCCANNS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-639-7377
Mailing Address - Street 1:15685 SW 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97224-2651
Mailing Address - Country:US
Mailing Address - Phone:503-639-7377
Mailing Address - Fax:503-620-2167
Practice Address - Street 1:15685 SW 116TH AVE
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:OR
Practice Address - Zip Code:97224-2651
Practice Address - Country:US
Practice Address - Phone:503-639-7377
Practice Address - Fax:503-620-2167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRP0000563CS3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy