Healthcare Provider Details

I. General information

NPI: 1083948129
Provider Name (Legal Business Name): 1622 VOORHIES AVE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 VOORHIES AVE
BROOKLYN NY
11235
US

IV. Provider business mailing address

1622 VOORHIES AVE
BROOKLYN NY
11235
US

V. Phone/Fax

Practice location:
  • Phone: 347-462-9778
  • Fax: 347-462-9781
Mailing address:
  • Phone: 347-462-9778
  • Fax: 347-462-9781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NATAN VINBAYTEL
Title or Position: PRESIDENT
Credential:
Phone: 212-260-4878