Provider Demographics
NPI:1023400983
Name:JJLM PHARMACY INC
Entity Type:Organization
Organization Name:JJLM PHARMACY INC
Other - Org Name:CIBAO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES,AO
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMORENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-316-4342
Mailing Address - Street 1:1303 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-7210
Mailing Address - Country:US
Mailing Address - Phone:212-543-1900
Mailing Address - Fax:212-543-1904
Practice Address - Street 1:1303 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-7210
Practice Address - Country:US
Practice Address - Phone:212-543-1900
Practice Address - Fax:212-543-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0335983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151508OtherPK
NY033598OtherREGISTRATION NUMBER