=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558666719
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FREYA PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2011
-----------------------------------------------------
Last Update Date | 11/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10119 39TH AVE
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11368-4806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-649-2525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10119 39TH AVE
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11368-4806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-649-2525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | MRS. SOOK CHA KIM
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 347-649-2525
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 030463
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------