MEDICARE: JAY PHARMACY CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	029079	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3352426	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1235213364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY PHARMACY CORP

Provider Business Mailing Address
First Line	:	1328 SAINT NICHOLAS AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-7213
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1328 SAINT NICHOLAS AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-7213
Country	:	US
Telephone Number	:	212-568-1383
Fax Number	:	212-568-1382

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAYESH LALIWALA
Credential	:
Telephone Number	:	212-568-1383

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	06/09/2009

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Directions to “JAY PHARMACY CORP ” Practice Location

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