Provider Demographics
NPI:1407904402
Name:JACOBS PILLS
Entity Type:Organization
Organization Name:JACOBS PILLS
Other - Org Name:HEALTHY CHOICE APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-238-1700
Mailing Address - Street 1:6 S GREELEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 S GREELEY AVE
Practice Address - Street 2:
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514-3311
Practice Address - Country:US
Practice Address - Phone:914-238-1700
Practice Address - Fax:914-238-1834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0261053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3314870OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY02513308Medicaid
3314870OtherOTHER ID NUMBER