Organization
1105 JTP LLC
Active
Other names
genome pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ISHBAY SHUKUROV (OWNER)
(516) 775-7775
Entity
Organization
Contact information
Practice address
1105 JERICHO TPKE, NEW HYDE PARK, NY 11040-4603
(516) 775-7775
Mailing address
1105 JERICHO TPKE, NEW HYDE PARK, NY 11040-4603
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
12/27/2019
Last updated
12/27/2019
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