| NPI | 1922884212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEX KAGZANOV Pharmacist In Charge 718-801-0994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 3336S0011X Pharmacy, Specialty Pharmacy |
| Enumeration Date | 2023-09-04 |
| Last Update Date | 2023-09-04 |