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General NPI Number Information
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NPI Number | 1609167196
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Entity Type | Organization
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Legal Business Name | PHARMACY DEPOT LLC
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Dates
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Enumeration Date | 05/02/2011
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Last Update Date | 05/02/2011
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Provider Practice Location Address
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Address Line | 317 BRIGHTON BEACH AVE
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City | BROOKLYN
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State | NY
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Zip | 11235-7412
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Country | US
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Telephone | 718-646-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 317 BRIGHTON BEACH AVE
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City | BROOKLYN
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State | NY
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Zip | 11235-7412
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | YELENA KUZNETSOVA
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Credential |
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Telephone | 718-646-0001
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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 | 030569
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License Number State | NY
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