Provider Demographics
NPI:1437327863
Name:GMJS PHARMACY INC
Entity Type:Organization
Organization Name:GMJS PHARMACY INC
Other - Org Name:LAVEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HIDALGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-233-3486
Mailing Address - Street 1:4320 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-2212
Mailing Address - Country:US
Mailing Address - Phone:718-937-0890
Mailing Address - Fax:718-784-2438
Practice Address - Street 1:4320 43RD AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2212
Practice Address - Country:US
Practice Address - Phone:718-937-0890
Practice Address - Fax:718-784-2438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0287283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2959231Medicaid
3357438OtherNCPDP PROVIDER IDENTIFICATION NUMBER