Healthcare Provider Details

I. General information

NPI: 1669892931
Provider Name (Legal Business Name): GIANT PITKIN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 PITKIN AVE
BROOKLYN NY
11207-3621
US

IV. Provider business mailing address

2232 PITKIN AVE
BROOKLYN NY
11207-3621
US

V. Phone/Fax

Practice location:
  • Phone: 347-955-5506
  • Fax: 347-406-7124
Mailing address:
  • Phone: 347-955-5506
  • Fax: 347-406-7124

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 Number032751
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KEN LEE
Title or Position: PRESIDENT, PIC
Credential: PHARM.D., RPH
Phone: 347-955-5506