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General NPI Number Information
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NPI Number | 1497909824
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Entity Type | Organization
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Legal Business Name | BB MYRTLE PHARMACY CORP
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Dates
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Enumeration Date | 11/12/2008
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Last Update Date | 11/17/2021
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Provider Practice Location Address
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Address Line | 141 CHARLES AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10302-1624
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Country | US
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Telephone | 718-720-5604
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Fax | 718-770-7687
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Provider Business Mailing Address
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Address Line | 826 FOREST AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10310-2446
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Country | US
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Telephone | 718-720-3710
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Fax | 718-360-9650
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Authorized Official
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Title or Position | CEO
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Name | BORIS NATENZON
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Credential |
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Telephone | 718-720-3710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 029308
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License Number State | NY
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