Provider Demographics
NPI:1649384611
Name:J D PHARMACY INC
Entity Type:Organization
Organization Name:J D PHARMACY INC
Other - Org Name:GROVE APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHOBHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-929-7527
Mailing Address - Street 1:302 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-6025
Mailing Address - Country:US
Mailing Address - Phone:212-929-7527
Mailing Address - Fax:212-229-0731
Practice Address - Street 1:302 W 12TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-6025
Practice Address - Country:US
Practice Address - Phone:212-929-7527
Practice Address - Fax:212-229-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0205413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01169319Medicaid
NY020541OtherNEW YORK STATE BOARD OF PHARMACY
3304716OtherNCPDP