MEDICARE: IJAK-UYIRE 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	3336L0003X	Long Term Care Pharmacy
2	3336C0003X	Community/Retail Pharmacy	021197	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	2063098	OTHER		PK

General Provider Information

NPI Number	:	1992708325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IJAK-UYIRE INC

Provider Business Mailing Address
First Line	:	77 02 21ST AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11370-1219
Country	:	US
Telephone Number	:	718-728-6878
Fax Number	:	718-728-6843

Provider Business Practice Location Address
First Line	:	77 02 21ST AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11370-1219
Country	:	US
Telephone Number	:	718-728-6878
Fax Number	:	718-728-6843

Authorized Official
Title or Position	:	SUPERVISING PHARMACIST
Name	:	OKON AKPAN
Credential	:
Telephone Number	:	718-728-6878

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/09/2016

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Directions to “IJAK-UYIRE INC ” Practice Location

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