1982953659 NPI number — JFGO HEALTH PHARMACIES LLC

Table of content: (NPI 1982953659)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982953659 NPI number — JFGO HEALTH PHARMACIES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JFGO HEALTH PHARMACIES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CITY CENTRE PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982953659
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2290 MCDANIEL ST STE 1A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
N LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89030-6330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-477-0311
Provider Business Mailing Address Fax Number:
702-477-0316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2290 MCDANIEL ST STE 1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89030-6330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-477-0311
Provider Business Practice Location Address Fax Number:
702-477-0316
Provider Enumeration Date:
09/10/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHUKWUKELU
Authorized Official First Name:
UDECHUKWUNYERE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
702-477-0311

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH02854 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2993081 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100529849 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".