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General NPI Number Information
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NPI Number | 1104736115
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Entity Type | Organization
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Legal Business Name | FORTUNE MEDICAL SUPPLY LLC
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Dates
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Enumeration Date | 09/10/2026
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 310 26TH AVE
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City | LONG ISLAND CITY
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State | NY
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Zip | 11102-4120
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Country | US
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Telephone | 646-344-0609
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Fax |
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Provider Business Mailing Address
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Address Line | 310 26TH AVE
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City | LONG ISLAND CITY
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State | NY
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Zip | 11102-4120
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Country | US
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Telephone | 646-344-0609
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | EUGENE BARNES
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Credential |
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Telephone | 646-344-0609
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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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