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General NPI Number Information
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NPI Number | 1538153200
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Entity Type | Organization
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Legal Business Name | JEFFERSON VALLEY PHARMACY INC
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Dates
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Enumeration Date | 09/08/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3693 HILL BLVD
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City | JEFFERSON VALLEY
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State | NY
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Zip | 10535
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Country | US
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Telephone | 914-962-6553
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Fax | 914-962-6228
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Provider Business Mailing Address
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Address Line | 3693 HILL BLVD
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City | JEFFERSON VALLEY
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State | NY
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Zip | 10535
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Country | US
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Telephone | 914-962-6553
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Fax | 914-962-6228
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DANIEL P BECKER
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Credential | RPH
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Telephone | 914-962-6553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 025541
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License Number State | NY
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