NPIMap

Organization Active NPI

Jeluca Pharmacy Corp

  • Community/Retail Pharmacy
  • White Plains, NY
National Provider Identifier
1467559385
Registry record updated Mar 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
026254 Issued in NY
Legal business name
JELUCA PHARMACY CORP
Practice address
811 N Broadway
White Plains, NY 10603-2400
Phone
(914) 949-6100
Fax
(914) 949-8630
NPI assigned
Sep 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jerry Mirra
Title
President
Phone
(914) 949-6100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 026254 NY Primary

Addresses

Primary practice location

811 N Broadway
White Plains, NY 10603-2400

Mailing address

811 N Broadway
White Plains, NY 10603-2400
Phone (914) 949-6100

Other identifiers 2

IdentifierTypeStateIssuer
02459465MedicaidNY
3334771OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • BROADWAY PHARMACY Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300838400000",
    "number": "1467559385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 N BROADWAY",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106032400",
            "telephone_number": "914-949-6100",
            "fax_number": "914-949-8630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 N BROADWAY",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106032400",
            "telephone_number": "914-949-6100",
            "fax_number": "914-949-8630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JELUCA PHARMACY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2011-03-23",
        "status": "A",
        "authorized_official_last_name": "MIRRA",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "914-949-6100"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "026254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02459465",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3334771",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BROADWAY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in White Plains, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.