Provider Demographics
NPI:1235681032
Name:JCPR CORP
Entity Type:Organization
Organization Name:JCPR CORP
Other - Org Name:GLASGOW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PRADEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILAKAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-838-8700
Mailing Address - Street 1:2600 GLASGOW AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4773
Mailing Address - Country:US
Mailing Address - Phone:302-838-8700
Mailing Address - Fax:302-838-8704
Practice Address - Street 1:2600 GLASGOW AVE STE 108
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5703
Practice Address - Country:US
Practice Address - Phone:302-838-8700
Practice Address - Fax:302-838-8704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
DEA3-00010063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166013OtherPK