Healthcare Provider Details

I. General information

NPI: 1790073906
Provider Name (Legal Business Name): PRIME HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 38TH AVE
LONG ISLAND CITY NY
11101-2609
US

IV. Provider business mailing address

3015 38TH AVE
LONG ISLAND CITY NY
11101-2609
US

V. Phone/Fax

Practice location:
  • Phone: 718-472-0900
  • Fax: 718-472-0909
Mailing address:
  • Phone: 718-472-0900
  • Fax: 718-472-0909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number030754
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH GALLO
Title or Position: PRESIDENT/SUPERVISING PHARMACI
Credential:
Phone: 718-472-0900