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General NPI Number Information
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NPI Number | 1376548545
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Entity Type | Organization
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Legal Business Name | THRIFTWAY FLATBUSH AVE. DRUG CORP.
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 07/19/2013
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Provider Practice Location Address
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Address Line | 542 FLATBUSH AVE
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City | BROOKLYN
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State | NY
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Zip | 11225-4804
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Country | US
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Telephone | 718-284-9800
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Fax | 718-462-5303
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Provider Business Mailing Address
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Address Line | 542 FLATBUSH AVE
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City | BROOKLYN
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State | NY
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Zip | 11225-4804
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Country | US
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Telephone | 718-284-9800
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Fax | 718-462-5303
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Authorized Official
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Title or Position | CORPORATE SECRETARY
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Name | ALEX PERCHUK
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Credential | RPH
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Telephone | 718-835-2000
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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 | 026138
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License Number State | NY
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