Healthcare Provider Details

I. General information

NPI: 1255415030
Provider Name (Legal Business Name): DITMAS PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 DITMAS AVE
BROOKLYN NY
11218-5001
US

IV. Provider business mailing address

509 DITMAS AVE
BROOKLYN NY
11218-5001
US

V. Phone/Fax

Practice location:
  • Phone: 718-675-0055
  • Fax: 718-675-1274
Mailing address:
  • Phone: 718-675-0055
  • Fax: 718-675-1274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number025147
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number025147
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number025147
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number025147
License Number StateNY

VIII. Authorized Official

Name: JOSEPH YARMOLINSKY
Title or Position: OWNER
Credential:
Phone: 718-675-0055