Provider Demographics
NPI:1720093362
Name:JAS HEALTHCARE INC
Entity Type:Organization
Organization Name:JAS HEALTHCARE INC
Other - Org Name:WELLS RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-567-1030
Mailing Address - Street 1:5 CHESWICK CT
Mailing Address - Street 2:DILIP SHAH
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194
Mailing Address - Country:US
Mailing Address - Phone:847-346-8249
Mailing Address - Fax:312-567-1040
Practice Address - Street 1:337 E 35TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3951
Practice Address - Country:US
Practice Address - Phone:312-567-1030
Practice Address - Fax:312-567-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.0168083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124716OtherPK