Provider Demographics
NPI:1952606212
Name:A & J PHARMACY LLC
Entity Type:Organization
Organization Name:A & J PHARMACY LLC
Other - Org Name:A & J PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-872-7575
Mailing Address - Street 1:45 WEBSTER COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-3813
Mailing Address - Country:US
Mailing Address - Phone:585-872-7575
Mailing Address - Fax:585-872-7515
Practice Address - Street 1:45 WEBSTER COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-3813
Practice Address - Country:US
Practice Address - Phone:585-872-7575
Practice Address - Fax:585-872-7515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0304993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3318509Medicaid
2128501OtherPK