Organization
JELUCA PHARMACY CORP
Active
Other names
BROADWAY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY MIRRA (PRESIDENT)
(914) 949-6100
Entity
Organization
Contact information
Practice address
811 N BROADWAY, WHITE PLAINS, NY 10603-2400
(914) 949-6100
(914) 949-8630
Mailing address
811 N BROADWAY, WHITE PLAINS, NY 10603-2400
(914) 949-6100
(914) 949-8630
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
026254
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02459465
—
NY
01
—
3334771
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/20/2006
Last updated
03/23/2011
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