| NPI | 1174616502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD ILYAICH Owner 718-933-1222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: NY 014956) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2021-10-12 |