Healthcare Provider Details

I. General information

NPI: 1770948515
Provider Name (Legal Business Name): WOODHAVEN DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6204B WOODHAVEN BLVD
REGO PARK NY
11374-2745
US

IV. Provider business mailing address

6204B WOODHAVEN BLVD
REGO PARK NY
11374-2745
US

V. Phone/Fax

Practice location:
  • Phone: 718-478-4600
  • Fax: 718-478-7731
Mailing address:
  • Phone: 718-478-4600
  • Fax: 718-478-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number034291
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LIHI MALACHOV
Title or Position: PRESIDENT
Credential:
Phone: 718-478-4600