MEDICARE: JNR PHARMACY BREWSTER 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	030737	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	2130592	OTHER		PK

General Provider Information

NPI Number	:	1740570829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JNR PHARMACY BREWSTER INC

Provider Business Mailing Address
First Line	:	2505 CARMEL AVE STE 111
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-1156
Country	:	US
Telephone Number	:	845-278-8200
Fax Number	:	845-278-4340

Provider Business Practice Location Address
First Line	:	2505 CARMEL AVE STE 110-111
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-1155
Country	:	US
Telephone Number	:	845-278-8200
Fax Number	:	845-278-4340

Authorized Official
Title or Position	:	PHARMACIST
Name	:	SRI TALLA
Credential	:
Telephone Number	:	845-392-8254

Provider Enumeration Date	:	04/11/2011
Last Update Date	:	04/25/2016

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Directions to “JNR PHARMACY BREWSTER INC ” Practice Location

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