Organization
JAE IL PHARMACY INC
Active
Other names
CORNER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ANNE PARK (SUPERVISING PHARMACIST)
(718) 460-3825
Entity
Organization
Contact information
Practice address
4103 UNION ST, FLUSHING, NY 11355-2452
(718) 460-3825
(718) 762-5842
Mailing address
4103 UNION ST, FLUSHING, NY 11355-2452
(718) 460-3825
(718) 762-5842
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
021251
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01764974
—
NY
01
—
3321142
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/12/2006
Last updated
07/06/2012
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