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General NPI Number Information
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NPI Number | 1730489956
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Entity Type | Organization
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Legal Business Name | MJJ PHARMACY INC
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Dates
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Enumeration Date | 10/22/2010
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Last Update Date | 03/17/2011
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Provider Practice Location Address
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Address Line | 25310 HILLSIDE AVE
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City | BELLEROSE
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State | NY
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Zip | 11426-2152
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Country | US
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Telephone | 718-413-7077
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Fax | 718-413-4757
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Provider Business Mailing Address
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Address Line | 25310 HILLSIDE AVE
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City | BELLEROSE
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State | NY
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Zip | 11426-2152
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Country | US
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Telephone | 718-413-7077
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Fax | 718-413-4757
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOEL GEORGE
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Credential |
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Telephone | 516-660-9380
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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 | 030420
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License Number State | NY
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