Provider Demographics
NPI:1760035497
Name:JEROME AVE PHARMACY LLC.
Entity Type:Organization
Organization Name:JEROME AVE PHARMACY LLC.
Other - Org Name:TAMMY CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROOQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-933-4000
Mailing Address - Street 1:2641 JEROME AVE
Mailing Address - Street 2:STORE #2
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-4349
Mailing Address - Country:US
Mailing Address - Phone:718-933-4000
Mailing Address - Fax:718-933-4001
Practice Address - Street 1:2641 JEROME AVE
Practice Address - Street 2:STORE #2
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-4349
Practice Address - Country:US
Practice Address - Phone:718-933-4000
Practice Address - Fax:718-933-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy