Provider Demographics
NPI:1790479442
Name:JACKSON AVE DRUGS INC
Entity Type:Organization
Organization Name:JACKSON AVE DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IBRAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-484-8553
Mailing Address - Street 1:660 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-1603
Mailing Address - Country:US
Mailing Address - Phone:718-484-8553
Mailing Address - Fax:718-484-8554
Practice Address - Street 1:660 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-1603
Practice Address - Country:US
Practice Address - Phone:718-484-8553
Practice Address - Fax:718-484-8554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy