Healthcare Provider Details

I. General information

NPI: 1710413109
Provider Name (Legal Business Name): KINGS 7TH AVE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 7TH AVE
BROOKLYN NY
11215-7251
US

IV. Provider business mailing address

300 7TH AVE
BROOKLYN NY
11215-7251
US

V. Phone/Fax

Practice location:
  • Phone: 718-499-5200
  • Fax:
Mailing address:
  • Phone: 718-499-5200
  • Fax: 718-499-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number035456
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number035456
License Number StateNY

VIII. Authorized Official

Name: RONALD DELGAUDIO
Title or Position: PRESIDENT/CEO
Credential:
Phone: 917-921-5656