Healthcare Provider Details

I. General information

NPI: 1548587173
Provider Name (Legal Business Name): EQUAL CARE III LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4059 COLLEGE POINT BLVD
FLUSHING NY
11354-5140
US

IV. Provider business mailing address

4059 COLLEGE POINT BLVD
FLUSHING NY
11354-5140
US

V. Phone/Fax

Practice location:
  • Phone: 718-888-9338
  • Fax: 718-888-9299
Mailing address:
  • Phone: 718-888-9338
  • Fax: 718-888-9299

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 Number030165
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL LEE
Title or Position: MEMBER/PIC
Credential: RPH
Phone: 718-888-9338