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General NPI Number Information
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NPI Number | 1588191415
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Entity Type | Organization
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Legal Business Name | DNA PHARMACY INC.
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Dates
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Enumeration Date | 05/23/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 10702 JAMAICA AVE
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City | RICHMOND HILL
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State | NY
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Zip | 11418-2239
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Country | US
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Telephone | 718-850-1100
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Fax | 718-850-1107
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Provider Business Mailing Address
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Address Line | 10702 JAMAICA AVE
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City | RICHMOND HILL
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State | NY
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Zip | 11418-2239
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Country | US
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Telephone | 718-850-1100
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Fax | 718-850-1101
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Authorized Official
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Title or Position | OWNER
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Name | OLEG LIVEYEV
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Credential | RPH
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Telephone | 718-850-1100
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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 | 035407
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License Number State | NY
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