MEDICARE: JRSTAT 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
2	3336C0003X	Community/Retail Pharmacy	028708	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2063060	OTHER		PK

General Provider Information

NPI Number	:	1508878166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JRSTAT PHARMACY INC

Provider Business Mailing Address
First Line	:	7107 13TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-1605
Country	:	US
Telephone Number	:	718-633-2988
Fax Number	:	718-633-6388

Provider Business Practice Location Address
First Line	:	7107 13TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-1605
Country	:	US
Telephone Number	:	718-633-2988
Fax Number	:	718-633-6388

Authorized Official
Title or Position	:	PRESIDENT
Name	:	XIAO YU LAU
Credential	:
Telephone Number	:	718-633-2988

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	03/15/2017

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Directions to “JRSTAT PHARMACY INC ” Practice Location

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