Healthcare Provider Details

I. General information

NPI: 1033652805
Provider Name (Legal Business Name): GOOD NATURE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 WASHINGTON AVE
BROOKLYN NY
11238-6104
US

IV. Provider business mailing address

805 WASHINGTON AVE
BROOKLYN NY
11238-6104
US

V. Phone/Fax

Practice location:
  • Phone: 718-636-5655
  • Fax: 718-636-9423
Mailing address:
  • Phone: 718-636-5655
  • Fax: 718-636-9423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number034678
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SEAN SCARBOROUGH
Title or Position: MANAGING EMPLOYEE
Credential:
Phone: 718-636-5655