Healthcare Provider Details

I. General information

NPI: 1235179771
Provider Name (Legal Business Name): JEFFERSON PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4892 STATE ROUTE 52
JEFFERSONVILLE NY
12748-5617
US

IV. Provider business mailing address

PO BOX 617
JEFFERSONVILLE NY
12748-0617
US

V. Phone/Fax

Practice location:
  • Phone: 845-482-5720
  • Fax: 845-482-5771
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number029537
License Number StateNY

VIII. Authorized Official

Name: MARIA NEUMANN
Title or Position: OPERATING OFFICER
Credential:
Phone: 845-482-5720