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General NPI Number Information
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NPI Number | 1215156526
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Entity Type | Organization
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Legal Business Name | K.R.D.PHARMACY,INC.DBA SUNNYSIDE
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 4811 SKILLMAN AVE
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City | SUNNYSIDE
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State | NY
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Zip | 11104-1025
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Country | US
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Telephone | 718-729-1400
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Fax | 718-729-1406
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Provider Business Mailing Address
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Address Line | 4811 SKILLMAN AVE
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City | SUNNYSIDE
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State | NY
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Zip | 11104-1025
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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 | RPH
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Name | DAVID FISHBAIN
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Credential |
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Telephone | 787-729-1400
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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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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 020254
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License Number State | NY
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