Healthcare Provider Details

I. General information

NPI: 1356703748
Provider Name (Legal Business Name): WZ PREMIUM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329A MYRTLE AVE
BROOKLYN NY
11205-3201
US

IV. Provider business mailing address

329A MYRTLE AVE
BROOKLYN NY
11205-3201
US

V. Phone/Fax

Practice location:
  • Phone: 718-938-0816
  • Fax: 718-744-5308
Mailing address:
  • Phone: 718-938-0816
  • Fax: 718-744-5308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number034592
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHENG WAN LIN
Title or Position: PRESIDENT
Credential:
Phone: 718-336-5883