Healthcare Provider Details

I. General information

NPI: 1497002935
Provider Name (Legal Business Name): EMA PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 KNICKERBOCKER AVE
BROOKLYN NY
11237-3702
US

IV. Provider business mailing address

380 KNICKERBOCKER AVE
BROOKLYN NY
11237-3702
US

V. Phone/Fax

Practice location:
  • Phone: 718-676-9976
  • Fax: 718-676-9986
Mailing address:
  • Phone: 718-676-9976
  • Fax: 718-676-9986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number031435
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5805950
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP PROVIDER IDENTIFICATION NUMBER

VIII. Authorized Official

Name: ELIE ALKADA
Title or Position: PRESIDENT
Credential:
Phone: 718-676-9976