Provider Demographics
NPI:1770670978
Name:JKM DRUGS INC
Entity Type:Organization
Organization Name:JKM DRUGS INC
Other - Org Name:FARMACIA SAN RAFAEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANOHARAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:212-923-4190
Mailing Address - Street 1:1479 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4002
Mailing Address - Country:US
Mailing Address - Phone:212-923-4190
Mailing Address - Fax:212-740-0341
Practice Address - Street 1:1479 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4002
Practice Address - Country:US
Practice Address - Phone:212-923-4190
Practice Address - Fax:212-740-0341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0170503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2060981OtherPK
NY01319011Medicaid
NY5302680001Medicare NSC