=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194018911
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | K.I.S. PHARMACY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2011
-----------------------------------------------------
Last Update Date | 05/26/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3050 AVENUE X
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11235-1204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-497-7333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3050 AVENUE X
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11235-1204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-497-7333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST/OWNER
-----------------------------------------------------
Name | MRS. KORINA SIGAL
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 917-975-5125
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------