Provider Demographics
NPI:1114682069
Name:JERICHO ROAD MINISTRIES INC.
Entity type:Organization
Organization Name:JERICHO ROAD MINISTRIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-881-6191
Mailing Address - Street 1:184 BARTON ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1573
Mailing Address - Country:US
Mailing Address - Phone:716-427-7650
Mailing Address - Fax:716-427-7651
Practice Address - Street 1:184 BARTON ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1573
Practice Address - Country:US
Practice Address - Phone:716-427-7650
Practice Address - Fax:716-427-7651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JERICHO ROAD MINISTRIES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy