Provider Demographics
NPI:1124025770
Name:JD RX INC
Entity Type:Organization
Organization Name:JD RX INC
Other - Org Name:TOWNLINE DRUG & SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC,TSR,SUPERVISING RPH
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BLATT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:631-361-4100
Mailing Address - Street 1:347 TERRY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5510
Mailing Address - Country:US
Mailing Address - Phone:631-361-4100
Mailing Address - Fax:631-361-4178
Practice Address - Street 1:347 TERRY RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5510
Practice Address - Country:US
Practice Address - Phone:631-361-4100
Practice Address - Fax:631-361-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4890760001332B00000X
NY26072333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02415947Medicaid
NY02415947Medicaid