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General NPI Number Information
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NPI Number | 1457866337
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Entity Type | Organization
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Legal Business Name | AHV PHARMACY, INC
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 12/13/2017
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Provider Practice Location Address
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Address Line | 11150 SPRINGFIELD BLVD
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City | QUEENS VILLAGE
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State | NY
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Zip | 11429-2542
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Country | US
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Telephone | 718-740-1237
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Fax | 718-740-1085
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Provider Business Mailing Address
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Address Line | 11150 SPRINGFIELD BLVD
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City | QUEENS VILLAGE
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State | NY
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Zip | 11429-2542
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Country | US
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Telephone | 718-740-1237
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Fax | 718-740-1085
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Authorized Official
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Title or Position | STORE OWNER
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Name | MR. ANISOV VITALIY
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Credential |
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Telephone | 718-740-1237
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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 | 035539
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License Number State | NY
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