Organization · NPI-2
Port Jervis Pharmacy LLC
Pharmacy, Community/Retail Pharmacy · Port Jervis, NY
NPI number1053426098
StatusActive
Last updated in NPPESMar 7, 2023
Details
- NPI
- 1053426098
- Entity type
- Organization (NPI-2)
- Legal business name
- Port Jervis Pharmacy LLC
- Organization subpart
- No
- Enumeration date
- Aug 20, 2006
- Last updated
- Mar 7, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | – | – | Yes |
| 333600000X | Pharmacy | 024124 | NY |
Other names
- Port Jervis Pharmacy (Doing Business As)
- Medicine Shoppe (Doing Business As)
Practice location
15 Jersey AvePort Jervis, NY 12771-2436
Phone 845-856-6681 · Fax 845-856-6532
Mailing address
15 Jersey AvePort Jervis, NY 12771-2436
Authorized official
Chirag Modi
Owner
7343772584
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