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General NPI Number Information
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NPI Number | 1003254194
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Entity Type | Organization
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Legal Business Name | PRIME DRUGS CORP.
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Dates
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Enumeration Date | 06/11/2013
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Last Update Date | 06/11/2013
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Provider Practice Location Address
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Address Line | 22417A UNION TPKE
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City | OAKLAND GARDENS
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State | NY
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Zip | 11364-3631
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Country | US
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Telephone | 718-749-5021
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Fax |
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Provider Business Mailing Address
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Address Line | 22417A UNION TPKE
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City | OAKLAND GARDENS
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State | NY
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Zip | 11364-3631
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Country | US
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Telephone | 718-749-5021
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YUIRY DAVYDOV
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Credential |
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Telephone | 718-749-5021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 031407
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License Number State | NY
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