Provider Demographics
NPI:1386410835
Name:JG PHARMACY SERVICES LLC
Entity type:Organization
Organization Name:JG PHARMACY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSUE
Authorized Official - Middle Name:
Authorized Official - Last Name:LISBOA PLATO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:787-955-7918
Mailing Address - Street 1:2437 PASEO PERLA DEL SUR
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0661
Mailing Address - Country:US
Mailing Address - Phone:787-841-3000
Mailing Address - Fax:787-293-9211
Practice Address - Street 1:2437 PASEO PERLA DEL SUR
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0661
Practice Address - Country:US
Practice Address - Phone:787-841-3000
Practice Address - Fax:787-293-9211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR039669500Medicaid