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General NPI Number Information
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NPI Number | 1619678216
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Entity Type | Organization
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Legal Business Name | PACKEDMED LLC
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Dates
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Enumeration Date | 03/13/2023
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 4604 AVENUE N
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City | BROOKLYN
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State | NY
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Zip | 11234-3615
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Country | US
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Telephone | 347-374-6964
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Fax |
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Provider Business Mailing Address
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Address Line | 4604 AVENUE N
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City | BROOKLYN
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State | NY
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Zip | 11234-3615
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Country | US
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Telephone | 347-374-6964
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NIDAL ADAM
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Credential |
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Telephone | 917-215-3055
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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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