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General NPI Number Information
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NPI Number | 1265922777
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Entity Type | Organization
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Legal Business Name | SKY88 LLC
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 13107 40TH RD STE E7
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City | FLUSHING
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State | NY
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Zip | 11354
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Country | US
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Telephone | 718-886-6222
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Fax | 718-886-9222
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Provider Business Mailing Address
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Address Line | 6151 231ST ST FL 1
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City | BAYSIDE
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State | NY
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Zip | 11364-2426
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Country | US
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Telephone | 812-240-5036
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAN LAM
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Credential |
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Telephone | 718-886-6222
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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 | NY
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