=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437327863
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GMJS PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2008
-----------------------------------------------------
Last Update Date | 03/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4320 43RD AVE
-----------------------------------------------------
City | SUNNYSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11104-2212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-937-0890
-----------------------------------------------------
Fax | 718-784-2438
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4320 43RD AVE
-----------------------------------------------------
City | SUNNYSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11104-2212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-937-0890
-----------------------------------------------------
Fax | 718-784-2438
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | MARTHA HIDALGO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-233-3486
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 028728
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------