MEDICARE: JNR 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	024990	NY
2	3336C0004X	Compounding Pharmacy	024990	NY
3	332B00000X	Durable Medical Equipment & Medical Supplies	024990	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

General Provider Information

NPI Number	:	1780751305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JNR PHARMACY CORP

Provider Business Mailing Address
First Line	:	2505 CARMEL AVE
Second Line	:	ROUTE 6
City	:	BREWSTER
State	:	NY
Zip	:	10509-1155
Country	:	US
Telephone Number	:	845-278-8200
Fax Number	:	845-278-4340

Provider Business Practice Location Address
First Line	:	2505 CARMEL AVE
Second Line	:	ROUTE 6
City	:	BREWSTER
State	:	NY
Zip	:	10509-1155
Country	:	US
Telephone Number	:	845-278-8200
Fax Number	:	845-278-4340

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JORGE A RESTREPO
Credential	:	RPH
Telephone Number	:	845-278-8200

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	09/11/2025

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Directions to “JNR PHARMACY CORP ” Practice Location

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