Provider Demographics
NPI:1629414347
Name:MJ88 PHARMACY INC
Entity Type:Organization
Organization Name:MJ88 PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:917-603-9077
Mailing Address - Street 1:6136 SPRINGFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2336
Mailing Address - Country:US
Mailing Address - Phone:718-819-0881
Mailing Address - Fax:718-819-0891
Practice Address - Street 1:6136 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11364-2336
Practice Address - Country:US
Practice Address - Phone:718-819-0881
Practice Address - Fax:718-819-0891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0319763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6849910001Medicare NSC