=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265625875
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 902 FOSTER CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2007
-----------------------------------------------------
Last Update Date | 03/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 902 FOSTER AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11230-1363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-859-4100
-----------------------------------------------------
Fax | 718-859-0033
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 902 FOSTER AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11230-1363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-859-4100
-----------------------------------------------------
Fax | 718-859-0033
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MUSURMON NORKULOV
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-859-4100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 028501
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------