Healthcare Provider Details

I. General information

NPI: 1629173372
Provider Name (Legal Business Name): CMD ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136-10/12 38TH AVENUE
FLUSHING NY
11354
US

IV. Provider business mailing address

136-10/12 38TH AVENUE
FLUSHING NY
11354
US

V. Phone/Fax

Practice location:
  • Phone: 718-353-5737
  • Fax: 718-353-6197
Mailing address:
  • Phone: 718-353-5737
  • Fax: 718-353-6197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number027008
License Number StateNY

VIII. Authorized Official

Name: MR. WILLIMA Y. CHOI
Title or Position: MANAGEMENT MEMBER
Credential: RPH
Phone: 718-353-5737