Healthcare Provider Details

I. General information

NPI: 1689859217
Provider Name (Legal Business Name): GN PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NORTHERN BLVD STE 3A
GREAT NECK NY
11021-5314
US

IV. Provider business mailing address

800 NORTHERN BLVD STE 3A
GREAT NECK NY
11021-5314
US

V. Phone/Fax

Practice location:
  • Phone: 516-304-5380
  • Fax: 516-213-3445
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number028703
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANNAHID HOPKINS
Title or Position: PRESIDENT
Credential: PHRMD
Phone: 516-304-5380