Healthcare Provider Details

I. General information

NPI: 1508337023
Provider Name (Legal Business Name): GIGI SPECIALTY PHARMACY CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 PAGE AVE
STATEN ISLAND NY
10309-2611
US

IV. Provider business mailing address

55 PAGE AVE
STATEN ISLAND NY
10309-2611
US

V. Phone/Fax

Practice location:
  • Phone: 718-605-5550
  • Fax: 718-966-0800
Mailing address:
  • Phone: 917-593-0500
  • Fax: 718-966-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. GIHAN F TADOROS
Title or Position: PHARMACY SUPERVISOR/PHARMACY OWNER
Credential: PHARMACIST
Phone: 917-593-0500