Healthcare Provider Details

I. General information

NPI: 1982189171
Provider Name (Legal Business Name): JACKSON PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7102 37TH AVENUE
JACKSON HEIGHTS NY
11372
US

IV. Provider business mailing address

7102 37TH AVENUE
JACKSON HEIGHTS NY
11372
US

V. Phone/Fax

Practice location:
  • Phone: 718-255-6723
  • Fax: 718-255-6784
Mailing address:
  • Phone: 718-255-6723
  • Fax: 718-255-6784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. ABDUL H KHAN
Title or Position: PRESIDENT
Credential:
Phone: 718-255-6723