Organization Active NPI

JKM Drugs Inc

  • Community/Retail Pharmacy
  • New York, NY
National Provider Identifier
1770670978
Registry record updated Sep 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
017050 Issued in NY
Legal business name
JKM DRUGS INC
Practice address
1479 Saint Nicholas Ave
New York, NY 10033-4002
Phone
(212) 923-4190
Fax
(212) 740-0341
NPI assigned
Oct 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2022

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

Authorized official

Name
Debra Manoharan, MA
Title
Owner
Phone
(212) 923-4190

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 017050 NY Primary

Addresses

Primary practice location

1479 Saint Nicholas Ave
New York, NY 10033-4002

Mailing address

1479 Saint Nicholas Ave
New York, NY 10033-4002
Phone (212) 923-4190

Other identifiers 2

IdentifierTypeStateIssuer
2060981OtherPK
01319011MedicaidNY

Other names 1

  • FARMACIA SAN RAFAEL Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930054624 NY DME Supplier - Pharmacy 5294945267 Practice locations: New York, NY
O20210304002487 NY Part B Supplier - Mass Immunization (Roster Biller Only) 5294945267 Practice locations: New York, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
J K M Drugs Inc1479 Saint Nicholas Ave, New York, NY 10033-4002(212) 923-4190 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Heat & Cold Applications|Neuromuscular Elect Stimulators (NMES)/Supplies|Canes and/or Crutches|Walkers|Wheelchairs (Standard Manual… Does not accept assignmentParticipating since Sep 30, 2004

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1479 Saint Nicholas Ave
New York, NY 10033
Phone (212) 923-4190

Practitioners & affiliated clinicians

Practitioners 1

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": "1160179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664236800000",
    "number": "1770670978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1479 SAINT NICHOLAS AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100334002",
            "telephone_number": "212-923-4190",
            "fax_number": "212-740-0341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1479 SAINT NICHOLAS AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100334002",
            "telephone_number": "212-923-4190",
            "fax_number": "212-740-0341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JKM DRUGS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-07",
        "last_updated": "2022-09-27",
        "certification_date": "2022-09-27",
        "status": "A",
        "authorized_official_last_name": "MANOHARAN",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "212-923-4190",
        "authorized_official_credential": "MA"
    },
    "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": "017050",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2060981",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01319011",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FARMACIA SAN RAFAEL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FARMACIA SAN RAFAEL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.