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General NPI Number Information
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NPI Number | 1215007331
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Entity Type | Organization
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Legal Business Name | MICAELA INC .
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2501 BROADWAY
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City | ASTORIA
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State | NY
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Zip | 11106-3413
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Country | US
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Telephone | 718-721-3650
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Fax | 718-721-1220
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Provider Business Mailing Address
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Address Line | 2501 BROADWAY
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City | ASTORIA
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State | NY
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Zip | 11106-3413
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Country | US
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Telephone | 718-721-3650
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Fax | 718-721-1220
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ANASTASIA MASTROGIANNIS
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Credential | ESQ.
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Telephone | 718-721-3650
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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 | 022656
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 022656
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License Number State | NY
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