Healthcare Provider Details

I. General information

NPI: 1689021057
Provider Name (Legal Business Name): JMD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5809 WOODSIDE AVE
WOODSIDE NY
11377-3437
US

IV. Provider business mailing address

5809 WOODSIDE AVE
WOODSIDE NY
11377-3437
US

V. Phone/Fax

Practice location:
  • Phone: 929-522-0858
  • Fax: 929-522-0860
Mailing address:
  • Phone: 929-522-0858
  • Fax: 929-522-0860

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 Number034460
License Number StateNY

VIII. Authorized Official

Name: RONIKA SONI
Title or Position: PRESIDENT
Credential:
Phone: 929-522-0858