Healthcare Provider Details

I. General information

NPI: 1326537937
Provider Name (Legal Business Name): ADVANCED PHARMACY ONE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6929 MYRTLE AVE
GLENDALE NY
11385-7265
US

IV. Provider business mailing address

6929 MYRTLE AVE
GLENDALE NY
11385-7265
US

V. Phone/Fax

Practice location:
  • Phone: 347-916-1895
  • Fax: 347-916-1764
Mailing address:
  • Phone: 347-916-1895
  • Fax: 347-916-1764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VENIAMIN AVEZOV
Title or Position: PRESIDENT
Credential:
Phone: 347-916-1895