Healthcare Provider Details

I. General information

NPI: 1639627011
Provider Name (Legal Business Name): PITKIN PHARMACY & FOOD MART INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 PITKIN AVE
BROOKLYN NY
11212-5045
US

IV. Provider business mailing address

1601 PITKIN AVE
BROOKLYN NY
11212-5045
US

V. Phone/Fax

Practice location:
  • Phone: 717-484-8730
  • Fax: 718-484-8731
Mailing address:
  • Phone: 717-484-8730
  • Fax: 718-484-8731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number034851
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HAMID UMAR
Title or Position: PRESIDENT
Credential:
Phone: 718-484-8730