Provider Demographics
NPI:1639587819
Name:DRJ PHARMACY INC
Entity Type:Organization
Organization Name:DRJ PHARMACY INC
Other - Org Name:DRJ PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNIBA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:917-893-8452
Mailing Address - Street 1:1554 E 45TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3006
Mailing Address - Country:US
Mailing Address - Phone:917-541-2458
Mailing Address - Fax:917-893-8454
Practice Address - Street 1:10410 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-2822
Practice Address - Country:US
Practice Address - Phone:917-541-2458
Practice Address - Fax:917-893-8454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0329813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04397191Medicaid