Provider Demographics
NPI:1689028631
Name:JAYS HUNTING PARK PHARMACY LLC
Entity Type:Organization
Organization Name:JAYS HUNTING PARK PHARMACY LLC
Other - Org Name:JAY'S HUNTING PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JARROD
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-410-4545
Mailing Address - Street 1:2001 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-2813
Mailing Address - Country:US
Mailing Address - Phone:215-410-4545
Mailing Address - Fax:
Practice Address - Street 1:2001 W HUNTING PARK AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-2813
Practice Address - Country:US
Practice Address - Phone:215-226-0140
Practice Address - Fax:215-226-2520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP482639333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159141OtherPK