Healthcare Provider Details

I. General information

NPI: 1619349685
Provider Name (Legal Business Name): 222 JAMAICA ECONOMY DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22121 JAMAICA AVE
QUEENS VILLAGE NY
11428-2015
US

IV. Provider business mailing address

22121 JAMAICA AVE
QUEENS VILLAGE NY
11428-2015
US

V. Phone/Fax

Practice location:
  • Phone: 718-465-5196
  • Fax: 718-465-5196
Mailing address:
  • Phone: 718-465-5196
  • Fax: 718-465-5196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number022153
License Number StateNY

VIII. Authorized Official

Name: MR. ARTHUR C WEINER
Title or Position: PRESIDENT
Credential: RPH
Phone: 718-465-5196