Provider Demographics
NPI:1629150412
Name:JEMMISON HOLDING CORP
Entity Type:Organization
Organization Name:JEMMISON HOLDING CORP
Other - Org Name:D ALLEGROS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZNAK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-344-8663
Mailing Address - Street 1:252 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-1717
Mailing Address - Country:US
Mailing Address - Phone:973-344-8663
Mailing Address - Fax:973-344-1138
Practice Address - Street 1:252 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1717
Practice Address - Country:US
Practice Address - Phone:973-344-8663
Practice Address - Fax:973-344-1138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS003919003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4381700Medicaid
2056221OtherPK
3112365OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NJ0492610001Medicare NSC