Healthcare Provider Details

I. General information

NPI: 1346064946
Provider Name (Legal Business Name): PCMH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 FLATBUSH AVE
BROOKLYN NY
11217-2820
US

IV. Provider business mailing address

260 FLATBUSH AVE
BROOKLYN NY
11217-2820
US

V. Phone/Fax

Practice location:
  • Phone: 347-689-3650
  • Fax: 347-689-3206
Mailing address:
  • Phone:
  • Fax:

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: MAHA HADDAD
Title or Position: OWNER
Credential:
Phone: 917-652-2558