Healthcare Provider Details

I. General information

NPI: 1174446355
Provider Name (Legal Business Name): JAM RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 AVENUE M
BROOKLYN NY
11230-6361
US

IV. Provider business mailing address

1914 AVENUE M
BROOKLYN NY
11230-6361
US

V. Phone/Fax

Practice location:
  • Phone: 718-375-2400
  • Fax: 718-375-3805
Mailing address:
  • Phone: 718-375-2400
  • Fax: 718-375-3805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH WILSCHANSKI
Title or Position: VP
Credential:
Phone: 718-367-2000