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General NPI Number Information
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NPI Number | 1649289067
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Entity Type | Organization
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Legal Business Name | KINGS THIRD AVE. PHARMACY LLC
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1619 3RD AVE
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City | NEW YORK
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State | NY
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Zip | 10128-3459
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Country | US
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Telephone | 212-534-6000
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Fax | 212-534-6300
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Provider Business Mailing Address
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Address Line | 1619 3RD AVE
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City | NEW YORK
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State | NY
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Zip | 10128-3459
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Country | US
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Telephone | 212-534-6000
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Fax | 212-534-6300
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Authorized Official
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Title or Position | CLINICAL PHARMACIST
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Name | REBECCA MASSACHI
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Credential |
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Telephone | 718-230-3535
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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 | 025191
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License Number State | NY
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