Provider Demographics
NPI:1124130042
Name:J&K HEALTHCARE ENTERPRISES INC
Entity type:Organization
Organization Name:J&K HEALTHCARE ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARM D/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:FURBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-357-3371
Mailing Address - Street 1:1625 MOTTMAN RD SW STE 101
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-7833
Mailing Address - Country:US
Mailing Address - Phone:360-357-3371
Mailing Address - Fax:360-705-0570
Practice Address - Street 1:1625 MOTTMAN RD SW STE 101
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7833
Practice Address - Country:US
Practice Address - Phone:360-357-3371
Practice Address - Fax:360-705-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WAPHAR.CF.605561493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146044OtherPK
WA6015762Medicaid