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General NPI Number Information
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NPI Number | 1003487216
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Entity Type | Organization
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Legal Business Name | PHARMACY ON GRAND INC
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 7333 GRAND AVE
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City | MASPETH
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State | NY
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Zip | 11378-1523
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Country | US
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Telephone | 718-734-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 7333 GRAND AVE
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City | MASPETH
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State | NY
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Zip | 11378-1523
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIKHAIL HEIFITZ
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Credential |
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Telephone | 718-288-7722
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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 |
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License Number State |
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