Healthcare Provider Details

I. General information

NPI: 1376994798
Provider Name (Legal Business Name): AVK RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3904 CHURCH AVE
BROOKLYN NY
11203-2915
US

IV. Provider business mailing address

3904 CHURCH AVE
BROOKLYN NY
11203-2915
US

V. Phone/Fax

Practice location:
  • Phone: 718-484-9810
  • Fax: 718-484-8773
Mailing address:
  • Phone: 718-484-9810
  • Fax: 718-484-8773

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 Number034958
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: IRINA Y ARONOVA
Title or Position: PRESIDENT
Credential:
Phone: 718-969-3300