Provider Demographics
NPI:1780751305
Name:JNR PHARMACY CORP
Entity type:Organization
Organization Name:JNR PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RESTREPO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:845-278-8200
Mailing Address - Street 1:2505 CARMEL AVE
Mailing Address - Street 2:ROUTE 6
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-1155
Mailing Address - Country:US
Mailing Address - Phone:845-278-8200
Mailing Address - Fax:845-278-4340
Practice Address - Street 1:2505 CARMEL AVE
Practice Address - Street 2:ROUTE 6
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-1155
Practice Address - Country:US
Practice Address - Phone:845-278-8200
Practice Address - Fax:845-278-4340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024990332B00000X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02159020Medicaid
NY5587490001Medicare ID - Type Unspecified