Healthcare Provider Details

I. General information

NPI: 1699219097
Provider Name (Legal Business Name): EBA DRUG CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 FLATBUSH AVE
BROOKLYN NY
11210-2436
US

IV. Provider business mailing address

1490 FLATBUSH AVE
BROOKLYN NY
11210-2436
US

V. Phone/Fax

Practice location:
  • Phone: 718-421-8161
  • Fax: 718-421-8160
Mailing address:
  • Phone: 718-421-8161
  • Fax: 718-421-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: OLGHA BALLAS
Title or Position: OWNER
Credential:
Phone: 718-421-8161