Provider Demographics
NPI:1134738115
Name:UTICA EXPRESS PHARMACY INC
Entity type:Organization
Organization Name:UTICA EXPRESS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC JERIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUIS JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-484-1704
Mailing Address - Street 1:190 UTICA AVE
Mailing Address - Street 2:GROUND FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2939
Mailing Address - Country:US
Mailing Address - Phone:718-484-1704
Mailing Address - Fax:718-484-1700
Practice Address - Street 1:190 UTICA AVE
Practice Address - Street 2:GROUND FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2939
Practice Address - Country:US
Practice Address - Phone:718-484-1704
Practice Address - Fax:718-484-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RO00251300OtherNJ BOP