Healthcare Provider Details

I. General information

NPI: 1831409697
Provider Name (Legal Business Name): AVE J ROYAL CARE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 AVENUE J
BROOKLYN NY
11230-3605
US

IV. Provider business mailing address

1315 AVENUE J
BROOKLYN NY
11230-3605
US

V. Phone/Fax

Practice location:
  • Phone: 718-253-1030
  • Fax: 718-676-2665
Mailing address:
  • Phone: 718-253-1030
  • Fax: 718-676-2665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number030417
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SALIM FAOUR
Title or Position: MANAGER
Credential:
Phone: 917-442-2705