Provider Demographics
NPI:1144054388
Name:JIMENEZ ALVAREZ, RICKY JORDY
Entity type:Individual
Prefix:MR
First Name:RICKY
Middle Name:JORDY
Last Name:JIMENEZ ALVAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 W BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4004
Mailing Address - Country:US
Mailing Address - Phone:718-484-8590
Mailing Address - Fax:718-484-8589
Practice Address - Street 1:8 W BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4004
Practice Address - Country:US
Practice Address - Phone:718-484-8590
Practice Address - Fax:718-484-8589
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0410923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy