Provider Demographics
NPI:1922164805
Name:J & R PHARMACY INC
Entity Type:Organization
Organization Name:J & R PHARMACY INC
Other - Org Name:J AND R PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES, SP, PIC, AO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THAI
Authorized Official - Middle Name:YOU
Authorized Official - Last Name:KAII
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, BSPHARM
Authorized Official - Phone:917-204-9611
Mailing Address - Street 1:2302 MERMAID AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2208
Mailing Address - Country:US
Mailing Address - Phone:718-266-6286
Mailing Address - Fax:718-266-6386
Practice Address - Street 1:2302 MERMAID AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2208
Practice Address - Country:US
Practice Address - Phone:718-266-6286
Practice Address - Fax:718-266-6386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NY0281473336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02871034Medicaid
2068708OtherPK
NY02871034Medicaid