Healthcare Provider Details

I. General information

NPI: 1699082057
Provider Name (Legal Business Name): BIG APPLE PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3771 103RD ST
CORONA NY
11368-3191
US

IV. Provider business mailing address

3771 103RD ST
CORONA NY
11368-3191
US

V. Phone/Fax

Practice location:
  • Phone: 718-779-4450
  • Fax: 718-779-4453
Mailing address:
  • Phone: 718-779-4450
  • Fax: 718-779-4453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number030372
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BORIS ASHIROV
Title or Position: OWNER
Credential:
Phone: 718-779-4450