Healthcare Provider Details

I. General information

NPI: 1467955385
Provider Name (Legal Business Name): AV CHEMISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68-28 MYRTLE AVE
GLENDALE NY
11385
US

IV. Provider business mailing address

6828 MYRTLE AVE
GLENDALE NY
11385-7235
US

V. Phone/Fax

Practice location:
  • Phone: 929-387-8111
  • Fax: 800-490-6448
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DENNIS NEKTALOV
Title or Position: OFFICIAL
Credential:
Phone: 929-387-8111