Healthcare Provider Details

I. General information

NPI: 1831648138
Provider Name (Legal Business Name): KIOSK FLUSHING PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 KISSENA BLVD
FLUSHING NY
11355-3138
US

IV. Provider business mailing address

4101 KISSENA BLVD
FLUSHING NY
11355-3138
US

V. Phone/Fax

Practice location:
  • Phone: 718-463-2261
  • Fax: 718-762-7740
Mailing address:
  • Phone: 718-463-2261
  • Fax: 718-762-7740

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 Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number034867
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier04590130
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 2
Identifier2164536
Identifier TypeOTHER
Identifier State
Identifier IssuerPK

VIII. Authorized Official

Name: HIU CHENG
Title or Position: PRESIDENT
Credential:
Phone: 718-463-2261