Healthcare Provider Details

I. General information

NPI: 1265987994
Provider Name (Legal Business Name): 222 JAMAICA DRUG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 21 JAMAICA AVE
QUEENS VILLAGE NY
11428-2097
US

IV. Provider business mailing address

PO BOX 740054
BRONX NY
10474-0001
US

V. Phone/Fax

Practice location:
  • Phone: 718-465-5196
  • Fax: 718-468-7782
Mailing address:
  • Phone: 718-971-9391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number034857
License Number StateNY

VIII. Authorized Official

Name: JACOB JAMRON
Title or Position: CEO
Credential:
Phone: 718-971-9391