Provider Demographics
NPI:1366947848
Name:JAYS DRUG
Entity type:Organization
Organization Name:JAYS DRUG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER /OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAE
Authorized Official - Middle Name:KUAEN
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:323-731-4696
Mailing Address - Street 1:3170 W OLYMPIC BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2400
Mailing Address - Country:US
Mailing Address - Phone:323-731-4696
Mailing Address - Fax:323-731-0285
Practice Address - Street 1:3170 W OLYMPIC BLVD STE D
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2400
Practice Address - Country:US
Practice Address - Phone:323-731-4696
Practice Address - Fax:323-731-0285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty