Organization
JRA DRUG CORP
Active
Other names
JOSE PHARMACY AND SURIGAL SUPPLY
Organization subpart
No
Provider details
NPI number
Authorized official
JOSE LUIS SUSANA (PRESIDENT)
(212) 304-0101
Entity
Organization
Contact information
Practice address
506 W 207TH ST, NEW YORK, NY 10034-2609
(212) 304-0101
(212) 304-0788
Mailing address
506 W 207TH ST, NEW YORK, NY 10034-2609
(212) 304-0101
(212) 304-0788
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
042575
NY
3336C0003X
Community/Retail Pharmacy
Primary
028965
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2978976
—
NY
01
—
3358113
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/04/2008
Last updated
01/08/2020
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