Healthcare Provider Details

I. General information

NPI: 1801322706
Provider Name (Legal Business Name): 5407 PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5407 2ND AVE
BROOKLYN NY
11220-2669
US

IV. Provider business mailing address

5407 2ND AVE
BROOKLYN NY
11220-2669
US

V. Phone/Fax

Practice location:
  • Phone: 718-492-9800
  • Fax: 718-492-1900
Mailing address:
  • Phone: 718-492-9800
  • Fax: 718-492-1900

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: MS. DALIA CHOUDHRY
Title or Position: PRESIDENT
Credential:
Phone: 917-531-1213