Healthcare Provider Details

I. General information

NPI: 1114915774
Provider Name (Legal Business Name): BRITTANY PHARMACY CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 AVENUE X
BROOKLYN NY
11223-6004
US

IV. Provider business mailing address

395 AVENUE X
BROOKLYN NY
11223-6004
US

V. Phone/Fax

Practice location:
  • Phone: 718-339-3131
  • Fax: 718-339-9232
Mailing address:
  • Phone: 718-339-3131
  • Fax: 718-339-9232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number025310
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number025310
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number025310
License Number StateNY

VIII. Authorized Official

Name: MRS. LUBA BALYASNY
Title or Position: PHARMACIST/OWNER
Credential: RPH
Phone: 718-339-3131