Healthcare Provider Details

I. General information

NPI: 1992231989
Provider Name (Legal Business Name): FOREST HILLS ORGANICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11712 QUEENS BLVD
FOREST HILLS NY
11375-7052
US

IV. Provider business mailing address

11712 QUEENS BLVD
FOREST HILLS NY
11375-7052
US

V. Phone/Fax

Practice location:
  • Phone: 718-487-3570
  • Fax: 718-487-3691
Mailing address:
  • Phone: 718-487-3570
  • Fax: 718-487-3691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number035463
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number035463
License Number StateNY

VIII. Authorized Official

Name: MR. ROBERT ISKHAKOV
Title or Position: PRESIDENT
Credential:
Phone: 917-642-3779