Provider Demographics
NPI:1134286529
Name:HOMEBOUND SOLUTIONS PHARMACY LLC
Entity Type:Organization
Organization Name:HOMEBOUND SOLUTIONS PHARMACY LLC
Other - Org Name:JAMAICA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-744-5020
Mailing Address - Street 1:1274 49TH ST
Mailing Address - Street 2:STE 157
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13506 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11418-1957
Practice Address - Country:US
Practice Address - Phone:718-291-6061
Practice Address - Fax:718-291-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0289253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3350270OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY02966892Medicaid
NY6225480001Medicare NSC