Provider Demographics
NPI:1225261381
Name:C&JS NORTHSIDE PHARMACY INC
Entity Type:Organization
Organization Name:C&JS NORTHSIDE PHARMACY INC
Other - Org Name:C&J'S NORTHSIDE PHARMACY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-455-6677
Mailing Address - Street 1:2301 TEALL AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-1691
Mailing Address - Country:US
Mailing Address - Phone:315-455-6677
Mailing Address - Fax:315-455-6678
Practice Address - Street 1:2301 TEALL AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-1691
Practice Address - Country:US
Practice Address - Phone:315-455-6677
Practice Address - Fax:315-455-6678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0297253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122570OtherPK
NY3215258Medicaid
3362996OtherNCPDP PROVIDER IDENTIFICATION NUMBER