Healthcare Provider Details

I. General information

NPI: 1326173774
Provider Name (Legal Business Name): 8TH AVENUE DRUGS & SURGICALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4821 8TH AVE
BROOKLYN NY
11220-2213
US

IV. Provider business mailing address

4821 8TH AVE
BROOKLYN NY
11220-2213
US

V. Phone/Fax

Practice location:
  • Phone: 718-437-2800
  • Fax: 718-437-3562
Mailing address:
  • Phone: 718-437-2800
  • Fax: 718-437-3562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number022652
License Number StateNY

VIII. Authorized Official

Name: MR. KEVIN P JIM
Title or Position: PHARMACIST
Credential: RPH
Phone: 718-437-2800