Healthcare Provider Details

I. General information

NPI: 1447576368
Provider Name (Legal Business Name): ELMONT PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 FULTON ST
BROOKLYN NY
11213-1124
US

IV. Provider business mailing address

13046 LAURELTON PKWY
ROSEDALE NY
11422-1219
US

V. Phone/Fax

Practice location:
  • Phone: 718-467-7000
  • Fax: 718-467-7002
Mailing address:
  • Phone: 718-869-9559
  • Fax: 718-467-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number030157
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHIOMA BARRAH
Title or Position: PRESIDENT
Credential:
Phone: 718-869-9559