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General NPI Number Information
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NPI Number | 1598828121
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Entity Type | Organization
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Legal Business Name | MYRTLE PHARMACY INC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 446A MYRTLE AVE
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City | BROOKLYN
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State | NY
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Zip | 11205-2414
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Country | US
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Telephone | 718-237-4444
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Fax | 718-237-1414
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Provider Business Mailing Address
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Address Line | 446A MYRTLE AVE
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City | BROOKLYN
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State | NY
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Zip | 11205-2414
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Country | US
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Telephone | 718-237-4444
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Fax | 718-237-1414
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID LEYBENGRUB
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Credential | PHARMACIST
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Telephone | 718-237-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 027115
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License Number State | NY
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