Provider Demographics
NPI:1871216382
Name:JCPR CORP
Entity type:Organization
Organization Name:JCPR CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JYOTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:PARNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-740-7996
Mailing Address - Street 1:3625 WRANGLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-1906
Mailing Address - Country:US
Mailing Address - Phone:302-838-8700
Mailing Address - Fax:
Practice Address - Street 1:3625 WRANGLE HILL RD
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-1906
Practice Address - Country:US
Practice Address - Phone:302-838-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JCPR CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-20
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD816404500Medicaid