1477598563 NPI number — JMC PHARMACY INC

Table of content: (NPI 1477598563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477598563 NPI number — JMC PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JMC PHARMACY INC
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:
JMC PHARMACY, INC. - FARMACIA LATINA
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:
1477598563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
93 15 ROOSEVELT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON HEIGHTS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-478-7968
Provider Business Mailing Address Fax Number:
718-478-7969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3875 BROADWAY UNIT A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10032-1567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-795-4909
Provider Business Practice Location Address Fax Number:
212-795-2043
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPON
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
Authorized Official Title or Position:
LEGAL
Authorized Official Telephone Number:
516-523-6948

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 015799 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00264493 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2060092 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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