Provider Demographics
NPI:1821152323
Name:JTAC2 INC
Entity Type:Organization
Organization Name:JTAC2 INC
Other - Org Name:MAIN MEDICAL PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:713-667-5003
Mailing Address - Street 1:10019 S MAIN ST # A-10
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5209
Mailing Address - Country:US
Mailing Address - Phone:713-667-5003
Mailing Address - Fax:713-667-5030
Practice Address - Street 1:10019 S MAIN ST # A-10
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5209
Practice Address - Country:US
Practice Address - Phone:713-667-5003
Practice Address - Fax:713-667-5030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145582Medicaid