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General NPI Number Information
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NPI Number | 1699827188
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Entity Type | Organization
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Legal Business Name | J.R. APOTHECARY LLC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1205 MAYBERRY PL
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City | MACEDON
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State | NY
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Zip | 14502-8774
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Country | US
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Telephone | 315-986-1500
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Fax | 315-986-5500
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Provider Business Mailing Address
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Address Line | 1205 MAYBERRY PL
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City | MACEDON
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State | NY
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Zip | 14502-8774
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Country | US
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Telephone | 315-986-1500
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Fax | 315-986-5500
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOSELITO GASPAR DELOSSANTOS
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Credential | RPH.
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Telephone | 585-748-2126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 028185
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License Number State | NY
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