Healthcare Provider Details

I. General information

NPI: 1447891635
Provider Name (Legal Business Name): 66 PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 E BROADWAY
NEW YORK NY
10002-6831
US

IV. Provider business mailing address

66 E BROADWAY
NEW YORK NY
10002-6831
US

V. Phone/Fax

Practice location:
  • Phone: 646-484-6683
  • Fax: 646-484-6547
Mailing address:
  • Phone: 646-484-6683
  • Fax: 646-484-6547

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: YU LIN
Title or Position: PRESIDENT
Credential:
Phone: 646-484-6683