Provider Demographics
NPI:1922322890
Name:RJ PHARMACY INC
Entity Type:Organization
Organization Name:RJ PHARMACY INC
Other - Org Name:RJ PHARMACY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:INCEKARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-691-3701
Mailing Address - Street 1:2111 WILLIAMSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1601
Mailing Address - Country:US
Mailing Address - Phone:347-691-3701
Mailing Address - Fax:347-691-3704
Practice Address - Street 1:2111 WILLIAMSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1601
Practice Address - Country:US
Practice Address - Phone:347-691-3701
Practice Address - Fax:347-691-3704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
NY0299823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03225418Medicaid
2124324OtherPK
6448910001Medicare NSC