Organization
PORT JERVIS PHARMACY LLC
Active
Other names
MEDICINE SHOPPE, Port Jervis Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CHIRAG MODI R.PH. (OWNER)
(734) 377-2584
Entity
Organization
Contact information
Practice address
15 JERSEY AVE, PORT JERVIS, NY 12771-2436
(845) 856-6681
(845) 856-6532
Mailing address
15 JERSEY AVE, PORT JERVIS, NY 12771-2436
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
024124
NY
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01879923
—
NY
01
—
3374496
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/20/2006
Last updated
03/07/2023
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