Provider Demographics
NPI:1144380585
Name:JAGLO PHARMACY INC
Entity Type:Organization
Organization Name:JAGLO PHARMACY INC
Other - Org Name:ROCKVILLE CENTRE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:516-764-6161
Mailing Address - Street 1:30 HEMPSTEAD AVE
Mailing Address - Street 2:SUITE 156
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4033
Mailing Address - Country:US
Mailing Address - Phone:516-764-6161
Mailing Address - Fax:516-678-3246
Practice Address - Street 1:30 HEMPSTEAD AVE
Practice Address - Street 2:SUITE 156
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4033
Practice Address - Country:US
Practice Address - Phone:516-764-6161
Practice Address - Fax:516-678-3246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3390337OtherNCPDP
NY01027870Medicaid
NY0260060001Medicare ID - Type Unspecified