Healthcare Provider Details

I. General information

NPI: 1174985485
Provider Name (Legal Business Name): NEW YORK METHODIST APOTHECARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST NEW YORK METHODIST APOTHECARY
BROOKLYN NY
11215-3609
US

IV. Provider business mailing address

501 6TH ST DEPARTMENT OF PHARMACY
BROOKLYN NY
11215-3671
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-5575
  • Fax:
Mailing address:
  • Phone: 718-780-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number490107010016415
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040428
License Number StateNY

VIII. Authorized Official

Name: MR. ERIC BALMIR
Title or Position: CHIEF OF PHARMACY
Credential: PHARM.D.
Phone: 718-780-5575