Healthcare Provider Details

I. General information

NPI: 1346432473
Provider Name (Legal Business Name): ELIYAHUS PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

573 KINGS HWY
BROOKLYN NY
11223-2003
US

IV. Provider business mailing address

573 KINGS HWY
BROOKLYN NY
11223-2003
US

V. Phone/Fax

Practice location:
  • Phone: 718-627-0485
  • Fax:
Mailing address:
  • Phone: 718-627-0485
  • Fax: 718-627-2757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number024117
License Number StateNY

VIII. Authorized Official

Name: ILIAS MLABASATI
Title or Position: R PH
Credential:
Phone: 718-627-0485