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General NPI Number Information
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NPI Number | 1114414083
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Entity Type | Organization
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Legal Business Name | PARK CHEMISTS 4 AV LLC
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | 500 4TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11215-4881
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Country | US
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Telephone | 718-567-4555
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Fax |
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Provider Business Mailing Address
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Address Line | 500 4TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11215-4881
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Country | US
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Telephone | 718-567-4555
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GARY VALEVICH
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Credential | PHARMD
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Telephone | 917-881-2970
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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 |
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License Number State |
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