=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245440767
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RED HOOK PHARMACY CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2007
-----------------------------------------------------
Last Update Date | 11/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 376 VAN BRUNT ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11231-1235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-797-0200
-----------------------------------------------------
Fax | 718-797-5090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 826 FOREST AVE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10310-2446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-720-3710
-----------------------------------------------------
Fax | 718-360-9650
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | BERNARD GLEZERMAN
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 718-797-0200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 026309
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------