| NPI | 1174921332 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGIY DAVIDOV Supervising Pharmacist 718-577-0200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2014-12-19 |
| Last Update Date | 2016-03-16 |