Provider Demographics
NPI:1871072579
Name:JRJ RAISELL PHARMACY DRUG CORP
Entity type:Organization
Organization Name:JRJ RAISELL PHARMACY DRUG CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:SUSANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-304-0101
Mailing Address - Street 1:741 ASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-9307
Mailing Address - Country:US
Mailing Address - Phone:347-955-3344
Mailing Address - Fax:347-955-3347
Practice Address - Street 1:741 ASTOR AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-9307
Practice Address - Country:US
Practice Address - Phone:347-955-3344
Practice Address - Fax:347-955-3347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy