MEDICARE: JEFFERSON PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	029537	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2141164	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235179771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERSON PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 617
Second Line	:
City	:	JEFFERSONVILLE
State	:	NY
Zip	:	12748-0617
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4892 STATE ROUTE 52
Second Line	:
City	:	JEFFERSONVILLE
State	:	NY
Zip	:	12748-5617
Country	:	US
Telephone Number	:	845-482-5720
Fax Number	:	845-482-5771

Authorized Official
Title or Position	:	OPERATING OFFICER
Name	:	MARIA NEUMANN
Credential	:
Telephone Number	:	845-482-5720

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	09/23/2014

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Directions to “JEFFERSON PHARMACY INC ” Practice Location

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