Provider Demographics
NPI:1235179771
Name:JEFFERSON PHARMACY INC
Entity Type:Organization
Organization Name:JEFFERSON PHARMACY INC
Other - Org Name:JEFFERSON PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-482-5720
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12748-0617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4892 STATE ROUTE 52
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12748-5617
Practice Address - Country:US
Practice Address - Phone:845-482-5720
Practice Address - Fax:845-482-5771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029537333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141164OtherPK
NY3114490Medicaid