Healthcare Provider Details

I. General information

NPI: 1629063367
Provider Name (Legal Business Name): B.O.P PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135-02 ROOSEVELT AVENUE
FLUSHING NY
11354-5343
US

IV. Provider business mailing address

135-02 ROOSEVELT AVENUE
FLUSHING NY
11354-5343
US

V. Phone/Fax

Practice location:
  • Phone: 718-359-6333
  • Fax: 718-359-5339
Mailing address:
  • Phone: 718-359-6333
  • Fax: 718-359-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number027290
License Number StateNY

VIII. Authorized Official

Name: CLEMENT HO
Title or Position: OWNER
Credential:
Phone: 718-539-8999