Healthcare Provider Details

I. General information

NPI: 1932245875
Provider Name (Legal Business Name): ASHLAND PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 DEKALB AVE
BROOKLYN NY
11217-1237
US

IV. Provider business mailing address

123 DEKALB AVE
BROOKLYN NY
11217-1237
US

V. Phone/Fax

Practice location:
  • Phone: 718-834-9884
  • Fax: 718-834-9567
Mailing address:
  • Phone: 718-834-9884
  • Fax: 718-834-9567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number020974
License Number StateNY

VIII. Authorized Official

Name: MR. EDWIN OMAR GBENEBITSE
Title or Position: SUPERVISING PHARMACISTS-PRESIDENT
Credential: R.PH,M.S
Phone: 718-834-9884