Healthcare Provider Details

I. General information

NPI: 1659626745
Provider Name (Legal Business Name): JACKSON HEIGHTS DRUGS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7510 ROOSEVELT AVE
JACKSON HEIGHTS NY
11372-6536
US

IV. Provider business mailing address

7510 ROOSEVELT AVE
JACKSON HEIGHTS NY
11372-6536
US

V. Phone/Fax

Practice location:
  • Phone: 718-406-9393
  • Fax: 718-406-9339
Mailing address:
  • Phone: 718-406-9393
  • Fax: 718-406-9339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number031381
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number031381
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number031381
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number031381
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number031381
License Number StateNY
# 10
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 11
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number031381
License Number StateNY

VIII. Authorized Official

Name: SHAHAB AHMED
Title or Position: PRESIDENT
Credential:
Phone: 718-406-9393