Healthcare Provider Details

I. General information

NPI: 1013239920
Provider Name (Legal Business Name): BRIAN KEITH FLYNN R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6404 18TH AVE
BROOKLYN NY
11204-3729
US

IV. Provider business mailing address

530 E 76TH ST
NEW YORK NY
10021-3138
US

V. Phone/Fax

Practice location:
  • Phone: 718-236-5705
  • Fax:
Mailing address:
  • Phone: 917-613-0504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number037469
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: