Provider Demographics
NPI:1336464825
Name:JEFFREY A MARKS
Entity Type:Organization
Organization Name:JEFFREY A MARKS
Other - Org Name:FRIENDSHIP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:585-610-2869
Mailing Address - Street 1:9 WEST MAIN STREET
Mailing Address - Street 2:PO BOX 128
Mailing Address - City:FRIENDSHIP
Mailing Address - State:NY
Mailing Address - Zip Code:14739
Mailing Address - Country:US
Mailing Address - Phone:585-973-3496
Mailing Address - Fax:585-973-3631
Practice Address - Street 1:9 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:FRIENDSHIP
Practice Address - State:NY
Practice Address - Zip Code:14739
Practice Address - Country:US
Practice Address - Phone:585-973-3496
Practice Address - Fax:585-973-3631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01462775Medicaid