Healthcare Provider Details

I. General information

NPI: 1285748251
Provider Name (Legal Business Name): 18TH AVE PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 18TH AVE
BROOKLYN NY
11204-1928
US

IV. Provider business mailing address

5411 18TH AVE
BROOKLYN NY
11204-1928
US

V. Phone/Fax

Practice location:
  • Phone: 718-331-3600
  • Fax: 718-331-3099
Mailing address:
  • Phone: 718-331-3600
  • Fax: 718-331-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number025629
License Number StateNY

VIII. Authorized Official

Name: GRIGORY BEYLIK
Title or Position: PRESIDENT
Credential:
Phone: 718-331-3600