Provider Demographics
NPI:1760242804
Name:JAXON PHARMACY, LLC
Entity Type:Organization
Organization Name:JAXON PHARMACY, LLC
Other - Org Name:ROWLAND HEIGHTS PHARMACY (LTC)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-464-0300
Mailing Address - Street 1:18777 COLIMA RD
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2949
Mailing Address - Country:US
Mailing Address - Phone:909-839-0001
Mailing Address - Fax:626-474-2053
Practice Address - Street 1:18777 COLIMA RD
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2949
Practice Address - Country:US
Practice Address - Phone:909-839-0001
Practice Address - Fax:909-839-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy