# ST. JESUS PHARMACY CORP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ST JESUS PHARMACY LTC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083435416
- **Authorized official:** VIRAJ DESAI (PRESIDENT)
- **Authorized official phone:** (212) 923-5733

## Contact information

- **Practice address:** 4180 BROADWAY, NEW YORK, NY 10033-3767
- **Practice address phone:** (212) 923-5733
- **Practice address fax:** (212) 923-5748
- **Mailing address:** 4180 BROADWAY, NEW YORK, NY 10033-3767
- **Mailing address phone:** (212) 923-5733
- **Mailing address fax:** (212) 923-5748

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 10/18/2024
- **Last updated:** 10/18/2024