Healthcare Provider Details

I. General information

NPI: 1477598563
Provider Name (Legal Business Name): JMC PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 BROADWAY UNIT A
NEW YORK NY
10032-1567
US

IV. Provider business mailing address

9315 ROOSEVELT AVE
JACKSON HEIGHTS NY
11372-7943
US

V. Phone/Fax

Practice location:
  • Phone: 212-795-4909
  • Fax: 212-795-2043
Mailing address:
  • Phone: 718-478-7968
  • Fax: 718-478-7969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number015799
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOSE CAMPON
Title or Position: PRESIDENT
Credential:
Phone: 212-795-7909