| NPI | 1699219097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLGHA BALLAS Owner 718-421-8161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Additional Taxonomies | 3336S0011X Pharmacy Specialty Pharmacy |
| Enumeration Date | 2016-12-05 |
| Last Update Date | 2020-07-09 |