Healthcare Provider Details

I. General information

NPI: 1356341689
Provider Name (Legal Business Name): ADLIB PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 10/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21519 73RD AVE
OAKLAND GARDENS NY
11364-2928
US

IV. Provider business mailing address

21519 73RD AVE
OAKLAND GARDENS NY
11364-2928
US

V. Phone/Fax

Practice location:
  • Phone: 718-428-8200
  • Fax: 718-428-7783
Mailing address:
  • Phone: 718-428-8200
  • Fax: 718-428-7783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number027996
License Number StateNY

VIII. Authorized Official

Name: CHAIM KURZ
Title or Position: SUPERVISING PHCIST
Credential: RPH
Phone: 718-428-8200