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General NPI Number Information
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NPI Number | 1902925746
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Entity Type | Organization
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Legal Business Name | A J K PHARMACY INC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8823 AVE L
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City | BROOKLYN
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State | NY
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Zip | 11236-4781
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Country | US
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Telephone | 718-251-4005
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Fax | 718-251-4006
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Provider Business Mailing Address
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Address Line | 8823 AVE L
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City | BROOKLYN
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State | NY
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Zip | 11236-4781
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Country | US
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Telephone | 718-251-4005
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Fax | 718-251-4006
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JACK J WILSON
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Credential | RPH
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Telephone | 718-251-4005
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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 | 04795
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License Number State | NY
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