Healthcare Provider Details

I. General information

NPI: 1447314406
Provider Name (Legal Business Name): BNMB CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 51 QUEENS BLVD
SUNNYSIDE NY
11104
US

IV. Provider business mailing address

39 51 QUEENS BLVD
SUNNYSIDE NY
11104
US

V. Phone/Fax

Practice location:
  • Phone: 718-482-0003
  • Fax: 718-482-1919
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number027663
License Number StateNY

VIII. Authorized Official

Name: NATALIYA LIOUKHOVER
Title or Position: PRESIDENT
Credential:
Phone: 718-482-0003