| NPI | 1104301829 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VLADIMIR GAVRILOV President 718-749-5515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2018-09-27 |
| Last Update Date | 2018-09-27 |