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General NPI Number Information
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NPI Number | 1003108663
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Entity Type | Organization
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Legal Business Name | MEDI-SPACE PHARMA INC
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Dates
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Enumeration Date | 05/13/2011
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 4139 MAIN ST
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City | FLUSHING
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State | NY
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Zip | 11355-3132
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Country | US
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Telephone | 718-961-3373
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Fax | 718-961-3311
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Provider Business Mailing Address
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Address Line | 4139 MAIN ST
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City | FLUSHING
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State | NY
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Zip | 11355-3132
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Country | US
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Telephone | 718-961-3373
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Fax | 718-961-3311
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Authorized Official
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Title or Position | PRESIDENT
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Name | HILTON CHEUNG
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Credential |
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Telephone | 718-961-3373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 030843
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License Number State | NY
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