Healthcare Provider Details

I. General information

NPI: 1780751305
Provider Name (Legal Business Name): JNR PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 CARMEL AVE ROUTE 6
BREWSTER NY
10509-1155
US

IV. Provider business mailing address

2505 CARMEL AVE ROUTE 6
BREWSTER NY
10509-1155
US

V. Phone/Fax

Practice location:
  • Phone: 845-278-8200
  • Fax: 845-278-4340
Mailing address:
  • Phone: 845-278-8200
  • Fax: 845-278-4340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number024990
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number024990
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number024990
License Number StateNY

VIII. Authorized Official

Name: MR. JORGE A RESTREPO
Title or Position: PRESIDENT
Credential: RPH
Phone: 845-278-8200