| NPI | 1457866337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANISOV VITALIY Store Owner 718-740-1237 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: NY 035539) |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2017-12-13 |