Healthcare Provider Details

I. General information

NPI: 1225940042
Provider Name (Legal Business Name): MAJOR PHARMA MAM CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 HYLAN BLVD
STATEN ISLAND NY
10305-1907
US

IV. Provider business mailing address

1509 HYLAN BLVD
STATEN ISLAND NY
10305-1907
US

V. Phone/Fax

Practice location:
  • Phone: 718-400-8408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JALAL JIBRIL
Title or Position: OWNER
Credential:
Phone: 718-400-8408