Provider Demographics
NPI:1235677923
Name:866 EAST TREMONT PHARMACY LLC
Entity Type:Organization
Organization Name:866 EAST TREMONT PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-971-9391
Mailing Address - Street 1:PO BOX 740054
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10474-0001
Mailing Address - Country:US
Mailing Address - Phone:718-971-9391
Mailing Address - Fax:
Practice Address - Street 1:864B E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4201
Practice Address - Country:US
Practice Address - Phone:718-991-3532
Practice Address - Fax:718-608-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167720OtherPK