1105 Jtp LLC
NPI #1982243788 in New Hyde Park, New York
Provider Information
- NPI Number
- 1982243788
- Entity Type
- Organization
- Organization Name
- 1105 Jtp LLC
- Primary Specialty
- Pharmacy - Community/Retail Pharmacy
- Enumeration Date
- Dec 27, 2019
- Last Updated
- Dec 27, 2019
Practice Location
- Address
- 1105 JERICHO TPKE
- City
- New Hyde Park
- State
- New York
- ZIP Code
- 11040-4603
- Phone
- (516) 775-7775
Authorized Official
- Name
- MR. ISHBAY SHUKUROV
- Title
- OWNER
- Phone
- (516) 775-7775
Specialties & Taxonomy Codes
| Specialty |
|---|
| Pharmacy - Community/Retail Pharmacy — Community/Retail Pharmacy |
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