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General NPI Number Information
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NPI Number | 1740570829
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Entity Type | Organization
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Legal Business Name | JNR PHARMACY BREWSTER INC
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 2505 CARMEL AVE STE 110-111
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City | BREWSTER
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State | NY
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Zip | 10509-1155
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Country | US
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Telephone | 845-278-8200
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Fax | 845-278-4340
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Provider Business Mailing Address
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Address Line | 2505 CARMEL AVE STE 111
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City | BREWSTER
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State | NY
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Zip | 10509-1156
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Country | US
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Telephone | 845-278-8200
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Fax | 845-278-4340
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Authorized Official
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Title or Position | PHARMACIST
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Name | SRI TALLA
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Credential |
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Telephone | 845-392-8254
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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 | 030737
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License Number State | NY
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