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General NPI Number Information
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NPI Number | 1619028362
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Entity Type | Organization
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Legal Business Name | SUPERIOR PHARMACY
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 6010A KISSENA BLVD
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City | FLUSHING
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State | NY
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Zip | 11355
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Country | US
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Telephone | 718-445-8450
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Fax | 718-445-8450
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Provider Business Mailing Address
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Address Line | 6010A KISSENA BLVD
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City | FLUSHING
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State | NY
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Zip | 11355
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Country | US
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Telephone | 718-445-8450
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Fax | 718-445-8450
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. FARAMARZ FRED LATAI
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Credential | PHARMACIST
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Telephone | 718-445-8450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 040959
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License Number State | NY
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