Provider Demographics
NPI:1255474318
Name:JEMJAY DRUG INC
Entity Type:Organization
Organization Name:JEMJAY DRUG INC
Other - Org Name:BOWREYS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-276-7106
Mailing Address - Street 1:224 12 MERRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413
Mailing Address - Country:US
Mailing Address - Phone:718-276-7106
Mailing Address - Fax:718-276-7107
Practice Address - Street 1:224 12 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413
Practice Address - Country:US
Practice Address - Phone:718-276-7106
Practice Address - Fax:718-276-7107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0216243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01422288Medicaid
3330660OtherNCPDP PROVIDER IDENTIFICATION NUMBER