Healthcare Provider Details

I. General information

NPI: 1801952171
Provider Name (Legal Business Name): BED-STUY PHARMACY NY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1458 FULTON ST
BROOKLYN NY
11216-5365
US

IV. Provider business mailing address

1047 SURF AVE 2ND FLOOR
BROOKLYN NY
11224-2810
US

V. Phone/Fax

Practice location:
  • Phone: 718-221-4860
  • Fax: 718-221-4864
Mailing address:
  • Phone: 212-249-8202
  • Fax: 917-722-0851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: POSEIDON BELITSIS
Title or Position: PIC
Credential:
Phone: 917-830-2522