| NPI | 1669504007 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAVI K CHENNA Supervising Pharmacist 718-293-0040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: NY 029089) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2010-01-06 |