# JEFFERSON PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jefferson Pharmacy INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235179771
- **Authorized official:** MARIA NEUMANN (OPERATING OFFICER)
- **Authorized official phone:** (845) 482-5720

## Contact information

- **Practice address:** 4892 STATE ROUTE 52, JEFFERSONVILLE, NY 12748-5617
- **Practice address phone:** (845) 482-5720
- **Practice address fax:** (845) 482-5771
- **Mailing address:** PO BOX 617, JEFFERSONVILLE, NY 12748-0617

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 029537 | NY | Yes |

## Other

- **Enumeration date:** 06/06/2006
- **Last updated:** 09/23/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2141164 | PK | — |
| 05 | — | 3114490 | — | NY |