Provider Demographics
NPI:1780089599
Name:J A K PHARMA INC
Entity type:Organization
Organization Name:J A K PHARMA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RATHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEERAMACHANANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-561-4040
Mailing Address - Street 1:2343 ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-8111
Mailing Address - Country:US
Mailing Address - Phone:718-561-4040
Mailing Address - Fax:718-561-5237
Practice Address - Street 1:2343 ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-8111
Practice Address - Country:US
Practice Address - Phone:718-561-4040
Practice Address - Fax:718-561-5237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033293333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5812652OtherNCPDP
NY04017121Medicaid
NY04017121Medicaid
FJ4997550OtherDEA