| NPI | 1114422391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALKIYEL DAVYDOV Owner/AO 718-415-9548 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: CT PCY.0002370) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2018-07-19 |