Provider Demographics
NPI:1629604368
Name:JAFA PHARMACEUTICALS, INC.
Entity Type:Organization
Organization Name:JAFA PHARMACEUTICALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-987-6796
Mailing Address - Street 1:95 MONTGOMERY DR STE 108
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-6617
Mailing Address - Country:US
Mailing Address - Phone:707-525-1130
Mailing Address - Fax:707-525-8099
Practice Address - Street 1:95 MONTGOMERY DR STE 108
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-6617
Practice Address - Country:US
Practice Address - Phone:707-525-1130
Practice Address - Fax:707-525-8099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy