=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487059085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE CHEMISTS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2014
-----------------------------------------------------
Last Update Date | 11/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 69-21 164TH STREET STORE 3
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-969-1600
-----------------------------------------------------
Fax | 718-969-1602
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 69-21 164TH STREET STORE 3
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-969-1600
-----------------------------------------------------
Fax | 718-969-1602
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. YEFIM YAGUDAYEV
-----------------------------------------------------
Credential | PHARM D
-----------------------------------------------------
Telephone | 917-892-4215
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 032951
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------