Jefferson Pharma LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

031367 Issued in NY

Legal business name

JEFFERSON PHARMA LLC

Doing business as

Feel Good Pharmacy

Practice address

3058 3Rd Ave
Bronx, NY 10451-4605

Phone

(929) 777-9108

Fax

(929) 777-9109

NPI assigned

Apr 18, 2012

Last updated

Feb 2, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ravinder Rao Annamaneni

Title

Member

Phone

(929) 777-9108

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• FEEL GOOD PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Enrollment records 2

Locations

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

{
    "created_epoch": "1334707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643760000000",
    "number": "1487911368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3058 3RD AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104514605",
            "telephone_number": "929-777-9108",
            "fax_number": "929-777-9109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3058 3RD AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104514605",
            "telephone_number": "929-777-9108",
            "fax_number": "929-777-9109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON PHARMA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-18",
        "last_updated": "2022-02-02",
        "certification_date": "2022-02-02",
        "status": "A",
        "authorized_official_last_name": "ANNAMANENI",
        "authorized_official_first_name": "RAVINDER",
        "authorized_official_middle_name": "RAO",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "929-777-9108"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "031367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2136214",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03456062",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FEEL GOOD PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kenia Jeanniton, LCSW
• Harry Smith Jeanty
• Lisa Ann Jedacek, DMD, MPH
• Nadira Melissa Jeeuth
• Shakia Jeffers, LPN
• Christopher T Jefferson, LMSW
• Karen Jefferson, RPA
• Nicholas Jefferson, CASAC-G
• Jeffrey Cooper O.D., P.C. (Metro Optics)
• Jeffrey Cooper O.D., P.C. (Metro Optics)

• Community/Retail Pharmacy in Bronx, NY
• Providers in Bronx, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.