Healthcare Provider Details

I. General information

NPI: 1093238180
Provider Name (Legal Business Name): GOYDAN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150-29 CROSS BAY BLVD STORE 1
OZONE PARK NY
11417
US

IV. Provider business mailing address

150-29 CROSS BAY BLVD STORE 1
OZONE PARK NY
11417
US

V. Phone/Fax

Practice location:
  • Phone: 718-641-5010
  • Fax: 718-641-5012
Mailing address:
  • Phone: 718-641-5010
  • Fax: 718-641-5012

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: MOSHE PLISHTIYEV
Title or Position: PRESIDENT
Credential:
Phone: 718-641-5010