Provider Demographics
NPI:1699827188
Name:J.R. APOTHECARY LLC
Entity Type:Organization
Organization Name:J.R. APOTHECARY LLC
Other - Org Name:GANANDA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSELITO
Authorized Official - Middle Name:GASPAR
Authorized Official - Last Name:DELOSSANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:585-748-2126
Mailing Address - Street 1:1205 MAYBERRY PL
Mailing Address - Street 2:
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502-8774
Mailing Address - Country:US
Mailing Address - Phone:315-986-1500
Mailing Address - Fax:315-986-5500
Practice Address - Street 1:1205 MAYBERRY PL
Practice Address - Street 2:
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502-8774
Practice Address - Country:US
Practice Address - Phone:315-986-1500
Practice Address - Fax:315-986-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0281853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY028185OtherSTATE LICENSE NUMBER
NY028185OtherSTATE LICENSE NUMBER