1105 Jtp LLC
Pharmacy, Community/Retail Pharmacy in New Hyde Park, NY. Organization (NPI-2).
NPI number1982243788
StatusActive
Last updated in NPPESDec 27, 2019
Details
- NPI
- 1982243788
- Entity type
- Organization (NPI-2)
- Legal business name
- 1105 Jtp LLC
- Organization subpart
- No
- Enumeration date
- Dec 27, 2019
- Certification date
- Dec 27, 2019
- Last updated
- Dec 27, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | – | – | Yes |
Other names
- Genome Pharmacy (Doing Business As)
Practice location
1105 Jericho TpkeNew Hyde Park, NY 11040-4603
Phone 516-775-7775
Mailing address
1105 Jericho TpkeNew Hyde Park, NY 11040-4603
Authorized official
Ishbay Shukurov
Owner
5167757775
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