Provider Demographics
NPI:1982953659
Name:JFGO HEALTH PHARMACIES LLC
Entity Type:Organization
Organization Name:JFGO HEALTH PHARMACIES LLC
Other - Org Name:CITY CENTRE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:UDECHUKWUNYERE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUKWUKELU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-477-0311
Mailing Address - Street 1:2290 MCDANIEL ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-6330
Mailing Address - Country:US
Mailing Address - Phone:702-477-0311
Mailing Address - Fax:702-477-0316
Practice Address - Street 1:2290 MCDANIEL ST STE 1A
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6330
Practice Address - Country:US
Practice Address - Phone:702-477-0311
Practice Address - Fax:702-477-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPH028543336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2993081OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NV100529849Medicaid