Provider Demographics
NPI:1235213364
Name:JAY PHARMACY CORP
Entity Type:Organization
Organization Name:JAY PHARMACY CORP
Other - Org Name:SANTA MARIA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAYESH
Authorized Official - Middle Name:
Authorized Official - Last Name:LALIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-568-1383
Mailing Address - Street 1:1328 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-7213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1328 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-7213
Practice Address - Country:US
Practice Address - Phone:212-568-1383
Practice Address - Fax:212-568-1382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0290793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02992914Medicaid
3352426OtherNCPDP PROVIDER IDENTIFICATION NUMBER
6131400001Medicare NSC