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General NPI Number Information
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NPI Number | 1235793332
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Entity Type | Organization
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Legal Business Name | MYRTLE EXPRESS PHARMACY INC
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Dates
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Enumeration Date | 04/24/2019
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 6416 MYRTLE AVE
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City | GLENDALE
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State | NY
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Zip | 11385-6216
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Country | US
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Telephone | 929-298-0281
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Fax | 929-298-0282
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Provider Business Mailing Address
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Address Line | 6416 MYRTLE AVE
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City | GLENDALE
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State | NY
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Zip | 11385-6216
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Country | US
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Telephone | 929-298-0281
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Fax | 929-298-0283
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Authorized Official
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Title or Position | OFFICER
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Name | VICTOR RUBENOV
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Credential |
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Telephone | 929-298-0281
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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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