Provider Demographics
NPI:1578236477
Name:135 JERICHO PHARMACY CORP.
Entity Type:Organization
Organization Name:135 JERICHO PHARMACY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-523-9200
Mailing Address - Street 1:135 W JERICHO TURNPIKE
Mailing Address - Street 2:STORE 3
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746
Mailing Address - Country:US
Mailing Address - Phone:516-923-1060
Mailing Address - Fax:516-923-1059
Practice Address - Street 1:135 W JERICHO TURNPIKE
Practice Address - Street 2:STORE 3
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746
Practice Address - Country:US
Practice Address - Phone:516-923-1060
Practice Address - Fax:516-923-1059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy